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Monday, January 9, 2012

Revisiting UN Political Declaration on NCDs: Need for Follow-up

To remind those interested in prevention and control of NCDs, and to educate and motivate the public to raise their concern for effective implementation of the declaration's guidelines by their governments, and for my own records on this blog, I am reproducing the release which was issued earlier by the News & Media Division, the UN Department of Public Information is reproduced, for guidance and information. I shall be working shortly, over a period of time, on these contents to provide suitable links with other resources for readers' easy reference. A post, dated 10th January, 2012, with reference to this revised post, follows.

The Declaration:

Proclaiming the spread of
non-communicable diseases a socio-economic and development challenge of
“epidemic proportions,” Governments pledged on 19th September, 2011,to work with the United
Nations to adopt before the end of 2012 targets to combat heart disease,
cancers, diabetes and lung disease and to devise voluntary policies that cut
smoking and slashed the high salt, sugar and fat content in foods that caused
them.

World leaders joined Health and
Development Ministers in the consensus adoption of a wide-ranging Political
Declaration on the prevention and control of non-communicable diseases at the
opening of the General Assembly’s first ever summit on the deadly chronic
illnesses. Often referred to as “lifestyle” diseases because the majority of
them were preventable, illnesses from smoking, alcohol abuse, poor diets and
physical inactivity killed some 36 million people a year, mostly in low and
middle-income countries where they disproportionately affected people under
60.

“The prognosis is grim,” warned
Secretary-General Ban Ki-moon, who noted that only once before had the Assembly
convened at the ministerial level to sound the alarm on a global health issue,
when it had held its first summit on HIV/AIDS. Citing statistics from the World Health Organization (WHO), which saw deaths from non-communicable diseases
increasing by 17 per cent in the next decade, he said that in Africa, that
number would jump by 24 per cent.

Yet, as alarming as those figures
were, “we know how to drive them down”, he said, explaining that treating the
diseases could be affordable, while preventing them could cost next to nothing,
and even save money. “When people cycle to work instead of driving, they get
exercise and the planet is spared more greenhouse gas emissions,” he said,
adding that when children were fed a nutritious diet at school, attendance rose,
and those eating habits could last a lifetime. Moreover, a woman’s access to
quality screening and vaccines to prevent cervical cancer could save her life.

“We should encourage individuals
to make the smart choices that will protect their health. Exercise, eat well,
limit alcohol consumption and stop smoking,” he continued, stressing that if the
world came together to tackle non-communicable diseases, “we can do more than
heal individuals — we can safeguard our very future”. The Secretary-General
urged delegations to give the Political Declaration meaning through multiple,
concerted and tough actions. “An excellent foundation […], we must act together
to carry out its provisions and bring non-communicable diseases into our broader
global health and development agenda,” he declared.

The 65-paragraph text, the
centrepiece of the two-day meeting, acknowledged that the global burden and
threat of non-communicable diseases “constitutes one of the major challenges for
development in the twenty-first century” and notes the Assembly’s profound
concern at the sharp increase in deaths and disability they caused. It also
recognized that many chronic disease risk factors were driven by obesity, and
that mental and neurological disorders — including Alzheimer’s disease — also
added to the global non-communicable disease burden “for which there is a need
to provide equitable access to effective programmes and health-care
interventions”.

The Assembly noted with “grave
concern” the vicious cycle by which poverty, chronic diseases and other risk
factors fed off each other, creating a deadly spiral of sickness and
deprivation, which, among other things, negatively affected women, exacerbated
the impacts of HIV/AIDS, wreaked havoc on fragile health-care systems and
undermined development gains. Responding to such a dire and multifaceted
challenge called for a “whole of Government, whole of society” approach, led by
WHO but driven by Governments, which could raise the priority accorded to
non-communicable disease and emphasize prevention as the cornerstone of the
international community’s response to tackling them.

Committing to reduce risk factors
and create health-promoting environments, strengthen national policies and
health systems, bolster international cooperation and partnerships, and promote
research and development, Assembly Member States pledged to work with WHO, other
United Nations agencies and international organizations to develop, before the
end of 2012, “a comprehensive global monitoring framework, including a set of
indicators, capable of application across regional and country settings […] to
monitor trends and to assess progress made in implementing national strategies
and plans on non-communicable diseases”.

Finally by the Declaration, Member
States requested Secretary-General Ban to prepare two reports, in collaboration
with the Director-General of WHO and other stakeholders; one to be presented to
the Assembly’s sixty-seventh session on strengthening multisectoral preventive
actions, and the other, to be presented at the Assembly’s sixty-eighth session,
on progress to that end and towards achievement of the Millennium Development
Goals. That report would set the stage for a comprehensive 2014 review of the
status of the Declaration’s implementation.

In a compelling address, Dr.
Margaret Chan, Director-General of WHO, said medical professionals had long been
aware of the “ominous” trend of non-communicable diseases that encircled the
globe. They saw the patients, managed the complications, wrote the medical
bills and agonized over the huge costs to families. “We plead for lifestyle
changes and strict tobacco legislations,” she said.

Today’s high-level meeting must
be a wake-up call for Governments at the highest level — a watershed event that
replaces ignorance and inertia with awareness and right actions immediately,”
she declared. Heads of State and Government must be responsible because the
problem was too big: the response must come with equal power that commanded the
right protective policies across all sectors of Government.

Calling non-communicable diseases
“a slow-motion disaster,” she declared: “These are the diseases that break the
bank”. Left unchecked, they had the power to devour the benefits of economic
gains. Indeed, diabetes care already accounted for 15 per cent of some national
budgets. According to a study by Harvard University, over the next 20 years,
non-communicable diseases would cost the global economy more than $30 trillion —
or 48 per cent of the global gross domestic product (GDP) in 2010.

Noting that such diseases were
largely preventable through cost-effective measures, she called on Heads of
State and Government to “stand rock hard” against the “despicable” efforts of
the tobacco industry and their highly aggressive tactics. In terms of demand
reduction, increased tobacco taxes and prices could protect health and bring
considerable revenue to Governments. In addition, salt reduction was among the
most cost-effective and feasible public health interventions for those at risk
of cardiovascular disease. In the absence of urgent action, the rising
financial and economic costs of non-communicable diseases would rise to levels
beyond even the reach of the wealthiest countries. “You have the power to stop
or reverse the [non-communicable diseases] disaster,” and to ensure that
development was moving on a good path. “We must act now,” she urged.

“Let there be no doubt,” said
General Assembly President Nassir Abdulaziz Al-Nasser, “that non-communicable
diseases have reached epidemic proportions”. Indeed, they were altering
demographics, stunting development and impacting economic growth. As such, the
high-level meeting was a historic opportunity to set a new global agenda and to
advance the protection of the world’s vulnerable populations, he said, recalling
that everyone had the right to enjoy the highest attainable standard of physical
and mental health.

It had become unequivocally clear,
he said, that the WHO-backed “best buy” interventions that reduced the toll of
such deaths were workable and affordable solutions. Perhaps most significantly,
it was now clear that to prevent such diseases, Governments must adopt
approaches that went beyond the health sector. As for the Political
Declaration, he said: “Let this document reaffirm a vision that goes beyond
health, that also reflects the impact of non-communicable diseases on
development and our economies,” expressing his hope that it galvanize action and
guide efforts for years to come.

Princess Dina Mired, speaking on
behalf of the Union for International Cancer Control, said she hoped to be the
voice for the more than 360 million who would die from non-communicable diseases
in the next decade. But even as they looked to the United Nations to stop that
unnecessary loss of life, those hundreds of millions of people would be brought
up short by inadequacies in the Political Declaration. Indeed, while it noted
that chronic diseases were a great equalizer among the rich and poor, the
Declaration failed to recognize that the burden of those diseases was an
epidemic. “There is a [non-communicable disease] epidemic,” she argued,
pointing out that WHO said it, non-governmental organizations said it and, most
importantly, the 36 million who died this year proved it.

Stressing that non-communicable
diseases must be labelled adequately and appropriately, she said the Political
Declaration not only lacked clear and measurable targets, it was infused with
vague language. But, the facts were crystal clear and painfully emphatic:
“There are 36 million people dying each year — not possibly, not maybe,” she
said. Drawing comparisons to the Political Declaration on HIV/AIDS, which had
seized a once-in-a-lifetime opportunity to convert will into action, she
stressed that what got measured got done.

Today, the United Nations had the
responsibility to deliver “the right punch in this fight”, she said. It should
send a message to the world to reduce deaths from non-communicable diseases by
25 per cent by 2025 since there would be little accountability without clear
targets. Further, the future must be made tobacco-free, she said, noting that
it was estimated that 1 billion people would die from tobacco use this century.
Essential medicines must also be provided now. It was time to stop numbering
deaths and start counting survivors, she concluded.

The High-level meeting, which
heard from nearly 90 speakers, also featured two round-table discussions,
respectively on “The rising incidence, developmental and other challenges and
the social and economic impact of non-communicable diseases and their risk
factors,” and “Strengthening national capacities, as well as appropriate
policies, to address prevention and control of non-communicable diseases.

During the discussion on the
development challenges, Co-chaired by Andrew Lansley, Secretary of State for
Health of the United Kingdom, and Endang Rahayu Sedyaningsih, Minister of Health
of Indonesia, participants heard representatives of Member States and
organizations confirm the severity of the problem. Speakers also acknowledged
that individuals had a responsibility to change their behaviour so as to reduce
the risk factors for non-communicable diseases. They stressed, however, that
such change required raising awareness in addition to making healthy choices
available and affordable.

Participants in the second round
table stressed the urgency of boosting national capabilities. “Without such
urgency, we lose momentum and economic and social burdens will rise to an
unbearable level,” President Pál Schmitt of Hungary said as he opened the
discussions, which he Co-chaired with Salomon Chertorivski Woldenberg, Minister
for Health of Mexico. One area of prevention that had attracted much attention
in many countries was strategies for reducing tobacco use, many speakers said,
describing action taken on the taxation, advertising and regulation fronts as
well as the banning of smoking in public spaces.

In the plenary, the President of
the International Olympic Committee also delivered opening remarks. Speaking in the debate on
non-communicable diseases were the Presidents of Suriname (on behalf of the
Caribbean Community), Slovenia, Brazil, Nauru, Hungary, Namibia, Zimbabwe,
Swaziland, Senegal, Mozambique, Gabon, Guinea, Trinidad and Tobago, Kenya and
Austria.The Prime Ministers of Bangladesh,
Saint Vincent and the Grenadines, Barbados, Fiji, Bahamas, Swaziland, Tonga and
Mali also spoke.The Vice-President of the Maldives
spoke, as did the Deputy Prime Ministers of Equatorial Guinea and
Luxembourg. Also addressing the Assembly were
Foreign Ministers and other senior Government officials of France, Uruguay,
Indonesia (on behalf of the Association of South-East Asian Nations), China,
United States, Iran, United Kingdom, Algeria, Kazakhstan, South Africa, Rwanda,
Guyana, Australia, Botswana, Ghana, Estonia, United Republic of Tanzania,
Finland, Morocco, Ireland, Malaysia, New Zealand, Bahrain, Samoa, Israel,
Kyrgyzstan, Canada, Norway, Belgium, Sri Lanka, Honduras, Tunisia, Philippines,
Solomon Islands, Mongolia, Nigeria, Bosnia and Herzegovina, Germany, Jamaica,
Egypt, Côte d’Ivoire, Congo, India, Marshall Islands, Gambia, Peru, Cuba, United
Arab Emirates, Romania, and Turkey. The representative of Cameroon
also spoke. The Special Envoy of the King of
Jordan and the First Lady of Chile also delivered remarks, as did the European
Commissioner for Health and Consumer Policy of the European Union.

The General Assembly will
reconvene at 9:30 a.m. Tuesday, 20 September to open its one-day high-level
meeting on desertification, land degradation and drought in the context of
sustainable development and poverty eradication, which will feature two
interactive panels. At 10:15, the Assembly will continue and conclude its
High-level Meeting on the Prevention and Control of Non-communicable
Diseases.

Background

The General Assembly met today to
open a high-level meeting on the Prevention and Control of Non-communicable
Diseases. With a particular focus on developmental and other challenges, and
the social and economic impacts posed by those diseases, particularly in
developing countries, the two-day meeting was expected to include several
plenary sessions and three thematic roundtables on specific themes.

The Assembly had before it the
Secretary-General’s report on Prevention and control of non-communicable
diseases (document A/66/83), which states that worldwide, such diseases are
now responsible for more deaths than all other causes combined and represent a
new frontier in the fight to improve global health. It also stresses that,
while the international community has focused on communicable diseases, such as
HIV/AIDS, malaria and tuberculosis, the four main non-communicable diseases —
cardiovascular diseases, diabetes, cancers and chronic respiratory diseases —
have emerged relatively unnoticed in the developing world and are now becoming a
global epidemic.

According to
the report, 36 million people died in 2008 from non-communicable diseases,
representing 63 per cent of that year’s 57 million global deaths. It further
notes that in 2030, such diseases are projected to claim the lives of 52 million
people. The epidemic is fuelled, it says, by a combination of rising risk
factors, including tobacco use, an unhealthy diet, lack of physical activity and
harmful alcohol use. Moreover, the four main non-communicable diseases that
share those risk factors cause almost 80 per cent of all deaths from such
diseases.

The report further notes that
non-communicable diseases affect the developing world and lower-income
populations hardest; it highlights strong evidence linking poverty, lack of
education and other social determinants to such diseases and their risk
factors. A vicious cycle is created by the epidemic, whereby non-communicable
diseases and their risk factors worsen poverty, while poverty results in rising
rates of such diseases.

Providing
details on their global impact, the report says that death and disease from
non-communicable diseases now outstrip communicable diseases in every region
except Africa, where the rate of such diseases is quickly rising. By 2030,
non-communicable diseases are projected to cause nearly five times as many
deaths as communicable diseases worldwide, including in low- and middle-income
countries. Furthermore, the health and socio-economic toll of the
non-communicable disease epidemic is impeding achievement of the Millennium Development Goals — particularly Goals 4 and 5, on women’s and children’s health
— which are falling short of targets set in many countries.

According to the report, the
burden of these diseases in low- and middle-income countries goes beyond the
fact that those countries are home to the world’s largest populations.
Unplanned urbanization, ageing populations and the globalization of trade and
product marketing, particularly for tobacco, alcohol and food, have led to a
rise in the risk factors of such diseases. In addition, it says that the lack of
health-care capacity and social protection systems in lower-income countries
means that non-communicable diseases are more likely to cause people to become
sick and die from them at earlier ages.

The report suggests, however, that
these chronic or lifestyle diseases could be significantly reduced and
prevented, with millions of lives saved and untold suffering avoided, through
proven and affordable measures that are often complementary to global health
efforts already under way. It also suggests that the prevention of
non-communicable diseases would reduce poverty, particularly since the majority
of expenditures for treatment in low- and middle-income countries are paid
privately or from out-of-pocket health-care systems.

Among other things, the report
says that the impact of non-communicable diseases can be prevented with an
approach that incorporates cost-effective, population-wide health-care
interventions to address risk factors, known as public health “best buys”, such
as raising taxes on tobacco and banning advertising and smoking in public
places, and primary health-care measures to treat those who have contracted or
are at a high risk of contracting such diseases.

To that
end, the Secretary-General outlines five recommendations to further progress.
First, implement a complete Government approach to adopting population-wide
interventions that address risk factors. Second, undertake sustained primary
health-care measures, including prioritized packages of essential interventions,
along with palliative and long-term care, for those who already have
non-communicable diseases or who are at high risk of contracting them. Third,
strengthen the capacity of Member States to monitor such diseases and their risk
factors and determinants, especially in lower-income countries; social data
disaggregated by, for example, by gender, was also encouraged. Fourth, harness
lessons learned from national HIV/AIDS, tuberculosis and malaria programmes in
low- and middle-income countries for effective integration of communicable and
non-communicable disease initiatives. Finally, prioritize the prevention and
control of non-communicable diseases through commitments at the highest levels
by Governments, the private sector, civil society, the United Nations and
international organizations.

Opening Remarks

Opening the high-level meeting,
NASSIR ABDULAZIZ AL-NASSER, President of the General Assembly, said that all
over the world, people were dying of preventable deaths, health-care systems
were over-burdened and economic growth was curtailed due to the loss of healthy
workers. “Let there be no doubt that non-communicable diseases have reached
epidemic proportions,” he said, stressing that such diseases were the biggest
cause of death worldwide, with more than 36 million people dying from them each
year — accounting for 63 per cent of global deaths. “And these deaths could
largely have been prevented.” Indeed, non-communicable diseases were altering
demographics, stunting development and impacting economic growth.

He said the high-level meeting
represented a landmark event, as it was only the second time the Assembly had
met at that level to discuss an emerging health issue with a major
socio-economic impact. “This meeting is an historic opportunity to set a new
global agenda and to advance the protection of the world’s vulnerable
populations,” he said, recalling that everyone had the right to enjoy the
highest attainable standard of physical and mental health. It was everyone’s
responsibility to help realize that right. Recalling that Member States first
committed to reducing premature mortality due to non-communicable diseases at
the 2000 World Health Assembly, he cited several important developments.

It had become unequivocally clear,
he said, that “best buy” interventions that reduced the toll of such deaths were
workable and affordable solutions. It also was evident that the most rapid
improvements in public health were often realized from relatively inexpensive
interventions that started in childhood. Perhaps most significantly, it was now
clear that to prevent such diseases, Governments must adopt approaches that went
beyond the health sector. Citing examples, he said the health impact of
non-communicable diseases in some wealthy nations had been reduced through
advocacy, community mobilization, health-system organization, legislation and
regulation. In low-income countries, which had taken a less
“whole-of-Government” approach, premature deaths among women due to such
diseases had reached 58 per cent, versus 6 per cent in high-income
countries.

Today, global leaders had gathered
to consolidate the vision and road map devised over 10 years into a new global
agenda, he said, adding that the high-level meeting could mark a turning point:
an opportunity to make major advances by committing to set national targets for
reducing premature deaths from non-communicable diseases and promoting a
“whole-of-Government” approach to preventing and controlling them. But, if such
commitments were to have an impact, leaders must address the widening capacity
disparities among countries. “This requires thinking in terms of international
cooperation,” he stressed. States must work together to monitor, reduce risk
exposure and strengthen health care for affected persons.

Another paramount goal must be to
take steps for a strong, well-coordinated and effective response to scale up
technical support for developing countries under the leadership of the World
Health Organization (WHO). That meant assisting countries in incorporating
non-communicable diseases into poverty-reduction strategies and relevant social
and economic policies. With that, he encouraged leaders to share lessons
learned about strengthening national capacities and identifying ways to foster
international cooperation for years to come. As for the outcome document to be
adopted today, he said: “Let this document reaffirm a vision that goes beyond
health, that also reflects the impact of non-communicable diseases on
development and our economies,” expressing his hope that it galvanize action and
guide efforts for years to come.

United Nations Secretary-General BAN KI-MOON, stressing that three out of five people on Earth died from
non-communicable diseases, said today’s meeting — concerning only the second
health-related issue to be addressed at a special meeting of the General
Assembly — was a landmark event. “Our collaboration is more than a public
health necessity,” he said, highlighting the threat of non-communicable diseases
to development. “[Non-communicable diseases] hit the poor and vulnerable
particularly hard and drive them deeper into poverty.”

He said that more than 1 million
of the people dying from non-communicable diseases succumbed in the prime of
their lives, with the vast majority of them living in developing countries.
Women and children were affected differently and significantly by these
diseases. The world prognosis was grim, with WHO projecting that deaths from
those diseases worldwide would increase by 17 per cent in the next decade — and
by 24 per cent in Africa.

“These statistics are alarming —
but we know how to drive them down,” he said. Indeed, treating non-communicable
diseases could be affordable, while preventing could cost next to nothing and
even save money. For example, when a person cycled to work instead of driving,
they got exercise while also sparing the planet more greenhouse-gas emissions.
When a child was taught healthy eating habits by being fed a nutritious diet at
school, their attendance also went up. When a woman had access to quality
screening and vaccines to prevent cervical cancer, her life could be
saved.

Yet, health ministers could not
solve this problem on their own, he said. Governments must provide the right
incentives and individuals must protect their own health. Civic groups must
maintain pressure for responsible marketing and business must produce healthier
and more sustainable goods. Individuals should be encouraged to make smart
choices by exercising, eating well, limiting alcohol consumption and not
smoking. But even the healthiest individual could not escape toxic substances
in the environment, and air, water and land must be kept clean.

Stressing that States whose
populations were suffering from crippling disease could not progress, he said
early detection was in everyone’s interest. Early treatment also reduced pain,
cut costs and lowered the risk of disability or death. “We have to get
medicines to all who need them and those treatments need to be more affordable
and accessible,” he said, adding that he counted on Governments to lead the
way.

Affirming his strong belief in the
power of business to improve the world, he nonetheless acknowledged the
well-documented and shameful history of certain industry players who ignored
science — and sometimes even their own research — to put public health at risk
in order to protect their own profits. The fact that many more industry giants
acted responsibly proved the need to hold everyone accountable so that the
disgraceful actions of the few would not sully the reputation of the many who
were doing important work to foster progress.

He called on corporations that
profited from selling processed foods to children, including the media,
marketing and advertising companies, to act with the utmost integrity. Those
profiting from alcohol sales must also do their part to promote moderation in
alcohol consumption, while everyone could also work to end tobacco use. At the
same time, Governments should educate people and encourage healthier options, he
said.

“This will be a massive effort,
but I am convinced we can succeed,” he asserted, highlighting the need for
public-private partnerships, political vision and resource mobilization.
Underlining the leadership of the United Nations in combating AIDS, he stressed
that, while non-communicable diseases were different, many of the same tools
worked in response. Clearly, holistic action on health worked. In addition,
improving health systems improved health services. Involving all parts of
Government attacked all sides of the problem, while taking comprehensive action
was the best way to protect against diseases.

Addressing non-communicable
diseases was critical, not just for global health, but would also be good for
the economy, the environment and the global public good. “If we come together
to tackle non-communicable diseases, we can do more than heal individuals — we
can safeguard our very future,” he said, underscoring the excellent foundation
provided by the Political Declaration. He urged acting together to implement
its provisions “and bring non-communicable diseases into our broader global
health and development agenda”.

As the world community worked
together to reduce the risks, the “best buys” identified by WHO provided
excellent guidance, he said. Challenging Member States to step up
accountability for carrying out the Political Declaration, he suggested that “if
this document remains just a set of words, we will have failed in our obligation
toward future generations. But, if we give this Political Declaration meaning
through multiple, concerted and tough actions, we will honour our responsibility
to safeguard our shared future.”

MARGARET CHAN, Director-General of
the World Health Organization (WHO), said medical professionals were
already aware of the “ominous” trend of non-communicable diseases that encircled
the globe. They saw the patients, managed the complications, wrote the medical
bills and agonized over the huge costs to families. “We plead for lifestyle
changes and strict tobacco legislations.” she said. “Today’s high-level meeting
must be a wake-up call for Governments at the highest level” — a water-shed
event that replaced ignorance and inertia with awareness and right actions
immediately. Heads of State and Government must be responsible because the
problem was too big: the rise of non-communicable diseases was being driven by
rapid urbanization and the globalization of unhealthy lifestyles. The response
must come with equal power that commanded the right protective policies across
all sectors of Government.

She went on to say that
non-communicable diseases were a slow-motion disaster. While most developed
over time, unhealthy lifestyles were spreading around the world with stunning
speed and sweep. Developing countries had been taken by surprise. The initial
burden of those diseases had been first seen in rich countries, which had the
strength to develop ever better treatments, creating the idea that the issue was
under control. “This is not the case,” she said, noting that the appearance was
misleading and blunted the call for policy change.

Moreover, obesity rates had almost
doubled since 1980, she said. In some countries, more than 50 per cent of
adults was obese or overweight, a telltale sign that something was terribly
wrong. That was not the mark of a failure of individual willpower, but rather
of policies at the highest level. Processed foods high in salt and sugar had
become the new staple foods: they were readily available and heavily marketed,
the cheapest way to fill a hungry stomach.

“These are the diseases that break
the bank,” she said. “Left unchecked, they have the power to devour the
benefits of economic gains.” Diabetes care accounted for 15 per cent of
national budgets. According to a study by Harvard University, over the next
20 years, non-communicable diseases would cost the global economy more than
$30 trillion — or 48 per cent of the global gross domestic product (GDP) in
2010. In large parts of the developing world, chronic conditions were detected
late and most care was covered through out-of-pocket payments. Such diseases
delivered a two-punch blow to development: each year, billions of dollars of
national income were lost and millions of people were pushed below the poverty
line.

Noting that such diseases were
largely preventable through cost-effective measures, she called on Heads of
State and Government to “stand rock hard” against the “despicable” efforts of
the tobacco industry and their highly aggressive tactics. In terms of demand
reduction, increased tobacco taxes and prices could protect health and bring
considerable revenue to Governments. In addition, salt reduction was among the
most cost-effective and feasible public health interventions for those at risk
of cardiovascular disease. In the absence of urgent action, the rising
financial and economic costs of non-communicable diseases would rise to levels
beyond even the reach of the wealthiest countries. “You have the power to stop
or reverse the [non-communicable diseases] disaster,” and to ensure that
development was moving on a good path. “We must act now,” she urged.

Princess DINA MIRED, speaking on
behalf of the Union for International Cancer Control, said that as she spoke for
civil society, she hoped to be the voice for the more than 360 million who would
lose their lives to non-communicable diseases in the next decade. They looked
to the United Nations to stop that unnecessary loss of life, she said. While
armed with the statistics, as well as an understanding of the common factors and
the affordability of prevention, the world community nevertheless faced what was
rightly described as a “public health emergency in slow motion”.

Today, she said, it must be asked
why non-communicable diseases were left to flourish uncontrolled, particularly
in the developing world. Among other things, those illnesses — which included
cardiovascular diseases, cancers, diabetes and respiratory illnesses — had been
lumped together under one pseudonym. Even the name “non-communicable diseases”
made them seem unimportant, suggesting that because they were not contagious,
they were somehow less important.

She said that, while it was
convenient for the United Nations to divide the range of diseases between those
that were communicable and those that were not, that resulted in the former
group receiving more attention. Plus, it was generally thought that the
developing world was immune from those industrialized diseases. Among other
things, that mindset meant that, even though an individual in the developing
world might survive HIV/AIDS, tuberculosis and malaria, they stood a high chance
of dying from a non-communicable disease, rendering all the investments made in
combating communicable diseases useless.

Commenting on the Assembly’s
Political Declaration, she said it recognized the scale of the problem and
issued a call for action. It also noted that non-communicable diseases were a
great equalizer among the rich and poor and affirmed the right of everyone to
receive the highest standards of health care. Yet, it was disappointing that
the burden of non-communicable diseases was not recognized as an epidemic, but
diluted into a “problem of epidemic proportions”. “There is a [non-communicable
disease] epidemic,” she argued, pointing out that WHO said it, non-governmental
organizations said it and, most importantly, the 36 million who died this year
proved it.

Stressing that non-communicable
diseases must be labelled adequately and appropriately, she said the Political
Declaration not only lacked clear and measurable targets, but it was infused
with vague language. But, the facts were crystal clear and painfully emphatic:
“There are 36 million people dying each year — not possibly, not maybe,” she
said.

Drawing comparisons to the
Political Declaration on HIV/AIDS, which seized a once-in-a-lifetime opportunity
to convert will into action, she stressed that what got measured got done. It
was essential, therefore, to recognize that the state of current health care
regarding non-communicable diseases was bleak. Indeed, when her nearly
two-year-old son was diagnosed with leukaemia, she had been able to travel to
seek out suitable care for him. But others were not so lucky. The harsh
disparity between treatment for non-communicable diseases in the developed and
developing world was unacceptable. While prevention was the cornerstone of
stemming deaths from non-communicable diseases, the impact of preventative
programmes took time to take effect. In the meantime, Governments must take
responsibility for those suffering now.

She went to say that income from
the sales of tobacco and unhealthy food products might seem indispensable for
economic growth during the current downturn, but a longer view indicated that
the long-term costs were significant. As had been noted early on in the fight
against HIV/AIDS, the war could not be won without a war chest.
Non-communicable diseases by their very nature were complicated, and only a very
few countries currently had the capacity to address their “NCD” burden. The
call for lifestyle changes gave the impression that mere choices were involved.
But, when healthy food choices were unavailable or exercise facilities did not
exist, the result turned into life sentences.

Today, the United Nations had the
responsibility to deliver “the right punch in this fight”, she said. It should
send a message to the world to reduce deaths from non-communicable diseases by
25 per cent by 2025 since there would be little accountability without clear
targets. Further, the future must be made tobacco-free, she said, noting that
it was estimated that 1 billion people would die from tobacco use this century.
Essential medicines must also be provided now. It was time to stop numbering
deaths and start counting survivors, she concluded.

JACQUES ROGGE, President of the
International Olympic Committee, said the need to take more assertive
action against non-communicable diseases was obvious. “The problem is acute,”
he said. “The solution is at hand.” The Committee is committed to combating
non-communicable diseases through the promotion of physical activity and healthy
lifestyles. Calling for Governments, educational institutions, businesses and
non-governmental organizations to work together, he urged support for several
steps that could make a significant difference. Together, they could advocate
for more safe spaces for physical activity and sport. For one thing, children
should not be forced to play in vacant lots littered with broken glass.

In addition, new partnerships
could be built with sectors beyond sport — including transportation, finance and
urban planning — to expand the impact of sport in urban areas, he said.
Stakeholders could work with Governments and educators to increase the time
students devoted to physical education and encourage the development of both
sport infrastructure and sport organizations. Perhaps most importantly, he
called on delegates to help the Committee and other sport organizations forge
new partnerships with the United Nations. As a new Permanent Observer of the
United Nations and an active member of civil society, the Committee looked
forward to playing a continued role in the prevention and control of
non-communicable diseases.

Action

The Assembly then adopted by
consensus the resolution entitled, Political Declaration of the High-level
Meeting of the General Assembly on the Prevention and Control of
Non-communicable Diseases (document A/66/L.1).

Statements by countries leaders

DESIRE DELANO BOUTERSE, President
of Suriname, speaking on behalf of the Caribbean Community (CARICOM),
recalled that Heads of State and Government in her region had met four years ago
in Port of Spain, Trinidad and Tobago, to express alarm at the impact of
non-communicable diseases on their societies. That concern stimulated urgent
efforts in the region and at the international level to enlist greater attention
to address non-communicable diseases. The most notable outcome, in that
respect, was the adoption by the General Assembly of the landmark
resolution 64/265 (2010) on the Prevention and Control of Non-Communicable
Diseases. The resolution embodied the commitment to successfully combat
non-communicable diseases through a response that was urgent, comprehensive,
multisectoral and fully coordinated at the national, regional and global levels.

He said that the Political
Declaration was a concrete outcome of the “intense and sustained activity” that
had followed the adoption of that resolution. It was now clear that
non-communicable diseases were a “scourge”, particularly in developing
countries. Additionally, the world was challenged by the commercialization,
globalization and proliferation of unhealthy lifestyles. However,
“non-communicable diseases do not have to spell inevitable doom for our
countries and peoples”. The world now had the scientific knowledge, as well as
the technical capacity, required for an effective response to non-communicable
diseases. In that regard, the Declaration offered a “turning point” in the
fight against the “global tsunami of non-communicable diseases” at all levels
and provided a good platform for ongoing consideration of the development and
other impacts of those diseases by the international community.

For CARICOM States, the central
message of the Declaration was a global consensus on strengthened commitment to
action to address non-communicable diseases and their risk factors at all
levels. It stressed the importance of multisectoral approaches, with an
emphasis on the cost-effectiveness of involving all stakeholders. It further
committed to the implementation of a range of actions to combat those diseases
and their risk factors, including through specific follow-up initiatives. The
Declaration presupposed “well-structured national as well as global plans”,
which included clear targets and a set of indicators for measuring progress.
The CARICOM States were committed to ensuring that the Declaration did not turn
out to be a mere rhetorical agreement, but instead a “platform for resolute
action” by all States.

On a regional level, CARICOM
States had developed a Strategic Plan of Action that included standard-setting
for tobacco, salt, as well as nutritional labelling and elaboration of a new
primary-care policy and an annual "Caribbean Wellness Day”. It had also taken
the initiative to establish a Regional Sports Academy in Suriname. The regional
group felt the Declaration fell “somewhat short” of its expectations: it did
not elaborate a clear enough goal and corresponding road map for the global
non-communicable diseases campaign that it was launching, nor did it have a
global collaborative mechanism or strong reservations on the use of the term
“epidemic” in relation to the global spread of those diseases. Nonetheless, if
scrupulously implemented, the Declaration would contribute in meaningful ways to
achieving internationally agreed development goals.

On a final note, he suggested the
appointment of a Special Representative of the Secretary-General on
Non-Communicable Diseases. The seriousness of those illnesses warranted
universal access to medicines and technologies. It was urgent, therefore, for
international agreements, such as Trade-Related Aspects of Intellectual Property
Rights (TRIPS), to include measures to defend public health.

DANILO TÜRK, President of
Slovenia, reflecting on the “magnitude and the paradox” of the task
ahead, recalled that while an estimated 36 million people had died of
non-communicable diseases around the world in 2008, today was only the second
time that Heads of State and Government had convened in the General Assembly to
discuss the issue. Nearly 80 per cent of those who died lived in the developing
world, he said, adding “perhaps our global understanding of development remains
too limited”. Was development too driven by economic technicalities? Were
health issues still viewed as a matter for experts, and not for global
policymakers?, he asked.

The United Nations must take
courage from the fact that, in the recent past, a “broad, energetic and
well-coordinated global campaign” had made a significant difference in
countering the HIV/AIDS epidemic, he said. Moreover, in many countries,
Governments and health institutions had already developed effective systems of
prevention and cure for non-communicable diseases. The accessibility and
quality of medical services had improved and there was a better understanding of
the importance of lifestyle and prevention to counter non-communicable
diseases. In that respect, Slovenia had been among the initiators of the
European Partnership for Action Against Cancer.

“Prevention and cure require
resources — medical, technical, financial and organizational,” but all were
sadly lacking in the developing world, he said. The United Nations system,
therefore, must quickly provide the necessary options of multisectoral
strategies, a system of appropriate indicators by which to measure progress and
an institutional mechanism to enable effective global coordination. While there
remained more to do, the Political Declaration adopted at the current meeting
“goes a long way” to meeting that aim, he concluded.

DILMA ROUSSEFF, President of Brazil, stressed that the driving force behind today’s determination and
commitment to curb non-communicable diseases was the premature loss of life and
the suffering of people and their families. In Brazil, 72 per cent of
non-violent deaths among those younger than 70 years-old were due to those
diseases, which impacted the poorest and most vulnerable. The resulting
productivity losses and costs added up to 1 per cent of Brazil’s GDP. As result
of Brazil’s belief that access to medication was part of the human right to
health, the Government had increased access to medication for patients with
hypertension and diabetes. While it respected its intellectual property
commitments, Brazil was convinced that the flexibilities contained in the World Trade Organization’s (WTO) TRIPS agreement and the Doha declaration on the
matter, as well as WHO’s Global Strategy on Public Health, Innovation and
Intellectual Property were indispensable for polices that guaranteed the right
to health.

She said the Brazilian Government
was also intensifying its fight against the risk factors with the greatest
influence on the onset of non-communicable diseases: tobacco use, the harmful
use of alcohol, lack of physical activity and unhealthy diets. It was also
promoting the reformulation of public spaces and was promoting better eating
habits by encouraging breastfeeding and the labelling of foodstuffs, as well as
teaching healthy eating in schools. Voluntary agreements had been established
with the food industry for the elimination of trans-fats and reductions in
sodium levels in their products. The Government had also raised taxes on
cigarettes and was combating their illegal production and sale. It also had
implemented a zero-tolerance law forbidding driving by those who had consumed
alcohol. Brazil was committed to reducing deaths from breast cancer and
cervical cancer, which was still a serious health issue in vulnerable areas,
such as the north, through facilitating access to preventive exams, improving
the quality of mammograms and expanding treatment for cancer victims.

MARCUS STEPHEN, President of
Nauru, said his country was all too familiar with the growing crisis of
non-communicable diseases. The prevalence of diabetes had approached 14 per
cent, more than double the global average. Non-communicable diseases were a
rapidly increasing burden on the domestic budget and tested the Government’s
commitment to provide health care and social services. They also undermined
good governance and political stability by robbing community leaders of some of
their most productive years. Regrettably, the issue had not received the
attention it deserved, and international resources dedicated to tackling the
problem had been inadequate.

Recounting a number of domestic
initiatives, including the enactment of the 2009 Tobacco Control Act,
introduction of a sugar tax and launch of exercise and nutrition programmes, he
said Nauru occupied a niche in the global economy. Geographically isolated and
possessing little land suitable for agriculture, it could not compete with
larger countries in food production. “Nutritious food is a luxury that most of
my people cannot afford,” he acknowledged. Climate change added a new barrier,
as it threatened long-term food security. In the Pacific region, 75 per cent of
deaths by natural causes were attributable to non-communicable diseases.
Obesity rates topped 90 per cent in some countries, while nearly 45 per cent of
adults had high cholesterol. Non-communicable diseases were as much a threat to
the region as AIDS, malaria and dysentery were in other parts of the developing
world. The good news was that by implementing education programmes and giving
people access to healthy diet choices, those trends could be reversed.

PÁL SCHMITT, President of
Hungary, said the rapid global spread of non-communicable diseases was
unfolding when the economic climate was uncertain and fragile, putting pressure
on limited resources. “We need innovative solutions,” he said, citing the need
for new models of care rather than those centred on the hospital. That process
should include comprehensive programmes for integrated actions for prevention,
early detection and control of non-communicable diseases.

He said his country was strongly
committed to contributing to the global fight against non-communicable
diseases. The Government still had much to do, as high levels of morbidity and
mortality persisted, owing to such diseases. While Hungary had been successful
in that fight, “we have not yet been able to reach the breakthrough we would
like to see in influencing unhealthy lifestyles among our population”. Still,
Hungarians had a long history of knowledge-sharing and much experience in both
designing and implementing health-sector programmes adapted to local needs and
the scarcity of resources. Reaching set goals required identifying the target
and creating a long-term strategy that could be broken down into action plans
and achieved through “hard day-to-day work”.

HIFIKEPUNYE POHAMBA, President of
Namibia, said his country, like others, faced a growing incidence of
non-communicable diseases, such as cardiovascular disease, cancer, chronic lung
disease and diabetes. It also had seen high rates of tobacco smoking, alcohol
abuse and obesity. “We are concerned about the impact of these diseases on the
lives of our people,” as well as on the country’s socioeconomic development,
especially the public health system. Recalling several measures Namibia had
taken, including the adoption of the United Nations Framework Convention on
Tobacco Control, he said enforcement of those measures had been challenging,
especially in rural areas and informal settlements.

He said that given the gravity of
the challenge at hand, developing countries had taken a two-pronged approach to
fighting both communicable and non-communicable disease. He appealed for
international support, more inter-sectoral collaboration and public-private
partnerships to discourage the harmful marketing of tobacco, alcohol and
unhealthy food. Reiterating Namibia’s full support of the Secretary-General’s
efforts to raise awareness about the importance of preventing and controlling
non-communicable diseases, he said: “Together we can make a
difference.”

ROBERT GABRIEL MUGABE, President
of Zimbabwe, recalled that non-communicable diseases now accounted for
the majority of deaths worldwide, some 63 per cent in 2008. They would
undoubtedly put a further strain on already-burdened health-delivery systems in
the developing world. “This, I am afraid, will scuttle the realization of one
of the main objectives of the Millennium Development Goals.” WHO projected that
non-communicable diseases would increase 17 per cent globally, and the greatest
increase — 29 per cent — was expected to be in the African region. That must be
taken in the context of the devastation already caused on that continent by the
HIV/AIDS pandemic, he stressed, calling on the international community,
especially developed countries, to increase their assistance, particularly to
Africa, to prevent and control non-communicable diseases.

He said that the scourge of those
diseases placed an enormous social and economic burden on the fragile
health-delivery systems of developing countries. Today’s meeting must address
several questions, including: whether enough was being done to address the
modifiable factors contributing to the increase of non-communicable diseases;
and whether the capacities existed to provide treatment and research on new ways
to strengthen efforts to curb those diseases. Zimbabwe continued to prioritize
health issues, including non-communicable diseases. Training and
awareness-raising programmes were in place for health personnel in that area.
The country, while challenged by the abuse of tobacco and alcohol, also
struggled with the reduction of poverty, which restricted many families to a
rigid and unbalanced diet.

Zimbabwe welcomed the Declaration
adopted by the Assembly today, but felt that it did not adequately address some
of the core challenges facing developing countries as they grappled with the
scourge of non-communicable diseases, he said. Developed countries should make
timebound, concrete commitments to ensure access to medicines, appropriate
technology transfer, and training of health-care workers. His delegation was
also concerned that in the quest to protect trade-related aspects of
intellectual property rights “a human face is lost”, “there is a tendency to
forget that this is a situation of life and death to our affected people.”
International partners must grant flexibilities to allow pharmaceutical
companies in the global South to manufacture generic drugs, just as they had for
HIV/AIDS in the past few years.

MICHELINE CALMY-REY, President and
Foreign Minister of Switzerland, said that non-communicable diseases had
become not just an urgent health problem, but also a major global political
issue, owing to their impact on societies and economies. Since the main causes
of non-communicable diseases were linked to lifestyles and living conditions, a
substantial portion of the premature deaths they caused could be avoided. Those
factors, therefore, were vital in determining the necessary actions.

She said Switzerland had adopted a
pre-emptive approach involving preventive and health-promotion measures in the
fight against smoking and alcohol abuse. It had also promoted balanced diet and
exercise. Also in place were measures to work closely with the private sector,
research and development partners, the civil society and other actors in order
to better direct activities towards at-risk populations. Switzerland used a
similar approach in its development cooperation activities. It intended to step
up its efforts in the area of non-communicable diseases, without diverting
resources from the important area of communicable diseases. On the contrary, it
was necessary to find synergies between those two areas. Above all, it was
urgent to bring about a change in mindsets — a long-term task that would require
sustained political commitment.

ABDOULAYE WADE, President of
Senegal, said the United Nations initiative to convene today’s meeting
demonstrated the scope and breadth of its capacity for action. The future
projections of deaths from non-communicable diseases called for a greater focus
on the risks underlying those diseases. Noting that Senegal had taken early
steps to combat AIDS, he said his Government believed it was paramount for the
public to understand the causes of non-communicable diseases and to undertake
measures to curb them. To that end, Senegal had launched several programmes to
raise awareness and boost education on that issue.

Noting that the treatment for
non-communicable diseases typically called for sophisticated, often costly
equipment, he said it was important to consider the possibility of its local
production in Africa. That would contribute to economic growth while also allow
for specialization on the surrounding non-communicable diseases. Furthermore,
prevention was needed, in the broad sense and on the level of the individual.
This was why the coming decade should be named the Decade for the Prevention of
Non-communicable Diseases, he added.

ARMANDO EMILIO GUEBUZA, President
of Mozambique , said that the main public health problems in Mozambique
were still related to communicable disease, with HIV/AIDS, malaria and
tuberculosis constituting serious challenges. However, there was a steady
increase in the incidence of non-communicable diseases, posing a major
development problem. “Worrying figures” showed that non-communicable diseases
affected Mozambique’s citizens at an early stage of their lives, preventing them
from contributing effectively to the country’s economy — a serious
burden.

She said Mozambique, therefore,
had decided to include the fight against non-communicable diseases in its
national health policy, including through a national strategic plan approved in
2008. Due to shortage of resources, an integrated approach featuring technical
and other support was in place. Prevention was another main focus, with
screening available for many non-communicable diseases. In that respect, the
Government was fully committed to implementing the Brazzaville and Moscow
agreements in its effort to counter the four main non-communicable diseases,
among others.

ALI BONGO ONDIMBA, President of
Gabon, said that since the 2008 Libreville Declaration, his country had
committed to reducing the impact of non-communicable diseases and putting in
place monitoring systems. Public health policies focused on the quality of life
of Gabonese people. In national strategies and programmes, the Government had
highlighted education and prevention with respect to healthy lifestyles. There
were free screenings for diabetes and a new cancer institute would start its
operations in 2012.

Among the many challenges to be
met, he said Gabon needed more visibility at the statistical level to guide
programmes. His Government also advocated more epidemiological monitoring
systems to better track non-communicable diseases. He also drew attention to
the inherent links between chemical products and cancer. Today’s high-level
meeting allowed for reaching consensus on a platform for partnership that must
be set up for the prevention and management of non-communicable diseases. He
concluded by expressing support for the Secretary-General’s recommendations
contained in his report on non-communicable diseases.

NAMAN KEITA, Minister of Health of
Guinea, said that non-communicable diseases were a heavy burden for his
country. Diabetes rates were relatively high — in particular in the capital,
Conakry — and most cases remained undetected and untreated, as no screening was
available. As a result, about half of those with diabetes in Guinea died and
many suffered amputations of limbs. Bronchitis and asthma rates were also high,
he reported, as were those of other non-communicable diseases. Together,
non-communicable diseases had “high costs” for Guinea when they went untreated.
Along with WHO, the country was working within its Government structure to
implement a national programme for countering non-communicable diseases,
including by mobilizing national resources for that purpose.

KAMLA PERSAD-BISSESSAR, Prime
Minister of Trinidad and Tobago, asked how many delegates present today
suffered from a non-communicable disease. Amid a show of hands, she said:
“That underscores the importance of this very important discussion here today.”
While her country had seen great successes in public health, for the last
decade, heart disease had been the number one cause of death, accounting for 25
per cent of total deaths. Diabetes accounted for 14 per cent of total deaths,
and a significant part of the gross domestic product was being used to provide
care for persons with non-communicable diseases. As such, Trinidad and Tobago
had been at the forefront of advocating for national, regional and international
action to focus on such diseases as a development issue of global concern,
having proposed to the Assembly in 2009 that a high-level meeting be convened on
the matter.

Recognizing that the majority of
non-communicable disease risks did not have a medical origin, and thus, required
a non-medical solution, she said: “We need to change the dialogue and focus on
the social determinants of health”. Emphasis must be placed on research into
the man-made causes of non-communicable diseases; reduction of risk factors and
creating a shift towards protecting children’s future. Trinidad and Tobago
strongly endorsed the development of a global strategy for the prevention and
control of non-communicable diseases. She urged the Assembly to support the
creation of global targets for non-communicable disease prevention and control,
with a possible aim of reducing those diseases by 25 per cent by 2025. Also,
non-communicable diseases must be re-defined in terms of the conditions that
drove risk factors for their development. Finally, a scientific technical
working group should be created to devise a research agenda and establish the
framework for the global community to respond.

SHEIKH HASINA, Prime Minister of
Bangladesh, noting that non-communicable diseases were a growing
development challenge in her country, as well as the world, said the quest for
progress overall often left little thought for the impact on the environment and
the health of people and communities. Changing social and economic conditions
had increased the cases of cardiovascular and respiratory diseases, cancers,
diabetes, which now accounted for 60 per cent of global mortality and
61 per cent in Bangladesh. It was increasingly clear that the world could no
longer ignore those problems. Among other things, more attention must be paid
to food additives and the use of hormones. The excessive use of antibiotics
must also be curbed.

Underlining the great economic
burden non-communicable diseases placed on families, she said the “silent
epidemic” plunged people into poverty, while slowing economic growth in poor
countries like Bangladesh. Regulation on the food industry was needed, as well
as information on what constituted a healthy diet and the benefits of physical
activity. Boosting the availability of health facilities was also critical,
particularly in the developing world where services addressing non-communicable
diseases were often nonexistent or out of reach financially. For its part,
Bangladesh had imposed higher taxes on tobacco, banned public smoking and
undertaken the development of specialized hospitals. It was also offering
special incentives to the private sector to build health facilities. The
challenges required adequate resources, and she underscored the need for
adequate support from development partners, including access to affordable
medicines.

RALPH GONSALVES, Prime Minister of
Saint Vincent and the Grenadines, said the reason this meeting was being
held in New York at the General Assembly and not at the WHO headquarters in
Switzerland underlined the fact that the fallout of the non-communicable disease
epidemic was much wider than the health sector. The epidemic’s developmental
aspects must be addressed, including the disproportionate impact on poor people
and developing States and on the achievement of the Millennium Development
Goals.

He said that the Political
Declaration emanating from this meeting simply was not enough, and its consensus
must give impetus to a robust follow-up process and action plan that would,
among several things, acknowledge that the flexibilities inherent in the World
Trade Organization’s agreement on intellectual property rights could and must be
applied to the non-communicable disease epidemic. “We must also consider the
role of the State and civil society in promoting healthy lifestyles and
protecting local citizens from environmental harm and trade imbalances that make
an imported hamburger, French fries and a carbonated beverage cheaper and more
readily available than a nutritious, locally produced meal,” he said.

Quoting Hippocrates, who stated
that health is the greatest of human blessings, he concluded by saying: “If we
can collectively protect and preserve this blessing, the benefits will go well
beyond the longevity and productivity of individual citizens. It will have a
knock-on effect on the economies, societies and developmental prospects of
countries and regions.”

FREUNDEL STUART, Prime Minister of
Barbados, stressed that the Caribbean was the region of the Americas
most affected by the epidemic of non-communicable diseases. It accounted for
over two thirds of deaths in the region, resulting in an unsustainable burden on
its member nations’ fragile economies. “The economic and social gains made in
the Caribbean region over the last five decades are in grave danger if being
reversed without immediate, effective and aggressive action,” he warned. Those
concerns were reiterated in 2007 with the region’s adoption of the Declaration
of Port of Spain.

It was estimated that one in every
four Barbadians was affected by at least one non-communicable disease, he said.
Rising rates of obesity, poor nutrition, low rates of physical activity and
other risk factors were associated with a cultural lifestyle shift, and it was
projected that the incidence of non-communicable diseases in the country would
rise to one in three by 2025. It was critical to establish achievable goals and
objectives targeting that increase, and in that respect, Barbados had taken
specific, targeted action over the last five years. Those included creating a
Chronic Non-Communicable Diseases Unit; increasing by 50 per cent the dedication
of financial resources to fighting lifestyle-related diseases; and increasing
surveillance capacity for non-communicable diseases through the establishment of
the Barbados National Registry — the first of its kind in the Eastern Caribbean.

He said that Barbados was also
committed to working with the private sector and civil society on those issues,
and it supported the establishment of mechanisms to permit civil society’s
significant global involvement in responding to the challenge. It also favoured
the setting of time-bound targets. Its commitment to the Framework Convention
on Tobacco Control remained firm. While the Declaration adopted did not meet
Barbados’ expectations, it was a good platform for ongoing consideration by the
Assembly of the developmental and other impacts of non-communicable diseases.
Support for training, research and development, quality control, and monitoring
evaluation would greatly assist Barbados and other small island developing
States in their response to the challenge, he added.

COMMODORE JOSAIA VOREQE
BAINIMARAMA, Prime Minister of Fiji, said the figures spoke for
themselves. It was apparent that premature deaths caused by non-communicable
diseases reduced productivity, curtailed economic growth and posed significant
social challenges in most countries. Thus, they were not just a health concern,
but also a development and economic issue. The Pacific region, including Fiji,
had declared non-communicable diseases a crisis requiring urgent action. The
region recognized that national Governments bore the primary responsibility for
responding to the global epidemic, and Fiji had enacted an “NCD Strategic Plan
for 2010-2014” entitled “from womb to tomb with a double-edged sword —
everyone’s business”, which adopted the “3M model” targeting “mouth, muscle and
medicine”. Together, with efforts to meet Millennium Development Goals 4 and 5,
the approach ensured that women and children had access to quality health
services. It also included activities related to policy, physical environment,
lifestyle, clinical services and monitoring and evaluation. Multisectoral in
nature, it engaged the whole of Government and society.

He said that by addressing the
prevention and control of non-communicable diseases in the country, Fiji was
contributing to addressing non-communicable diseases worldwide. To that end, it
had been one of the first countries to receive an award from WHO for its
community-level tobacco-free initiatives, four of which were currently in
place. Fiji was also one of the first countries in the world to carry out the
first and second “WHO NCD STEPS” survey. Not all countries possessed the same
capability to tackle non-communicable diseases, and thus, he underlined the need
for strengthened international cooperation, particularly in increasing technical
assistance, technology transfer and capacity building, as well as access to
high-quality generic medicines.

HUBERT A. INGRAHAM, Prime Minister
and Minister of Finance of the Bahamas, aligning with the Group of 77
developing countries and China, said non-communicable diseases had strained his
country’s health-care system. Half of all public hospital beds were occupied by
people suffering from such ailments and 80 per cent of the drug costs for the
national prescription drug plan was spent on hypertension and diabetes. The
dual burden of both non-communicable and communicable diseases had led his
Government to strengthen primary health-care services, increase access to
medications for non-communicable diseases, promote healthy living and facilitate
patient self-management programmes, among other things.

While recognizing the important
leadership roles of the United Nations and WHO, he strongly recommended
increasing international and regional budgetary allocations; increasing access
to training in policy formulation, monitoring and coordination across health
systems; changing policies for intersectoral involvement in the
“non-communicable disease prevention initiative”; and sharing best practices in
trade and industry. He welcomed the adoption of the Political Declaration, but
noted shortfalls in the commitments to scale up resources and actions at all
levels, and more importantly, the lack of agreement on the establishment of an
effective follow-up mechanism.

BARNABAS SIBUSISO DLAMINI, Prime
Minister of Swaziland, said that the situation of non-communicable
diseases in his country was alarming. In 2009, data showed that hypertension
and heart disease accounted for more than 33,000 and 3,000 outpatient
consultations, respectively. Approximately 15 per cent of the population was
living with diabetes. A survey conducted with the support of WHO also showed
that those in the 25-35 age range had a 32 per cent risk of suffering from
non-communicable diseases, while those between 45 and 55 had a 50 per cent
risk. The situation demanded urgent attention, he said.

He said his country was committed
to achieving the six objectives of the 2008-2013 Action Plan for Global Health
Strategy and Control of Non-Communicable Diseases. A national non-communicable
diseases programme had been established, focusing on public awareness raising
and improved case management. The Health Ministry was also developing a
non-communicable diseases national policy, as well as a national strategic plan,
the key pillars of which would be surveillance, public awareness, targeted
interventions, early detection, better case management, palliative care and
research. All sectors would be involved. Finally, he lauded the positive steps
taken since 2009 to invite Taiwan — one of Swaziland’s most committed partners —
to participate in the World Health Assembly as an observer.

ULITI UATA, Prime Minister and
Minister of Health of Tonga, said that many Pacific territories had made
it to the top of several lists that no country should seek to top — including of
those with high diabetes rates. In Tonga, non-communicable diseases were the
main public health problem. Indeed, 90 per cent of adults were overweight and
40 per cent had diabetes or pre-diabetes. Four of the top causes of death among
Tongans were related to non-communicable diseases. Life expectancy had been
reduced as a result of the burden of non-communicable diseases. The Government
had responded by placing a high priority on those diseases in its development
framework. It also had developed strategies to strengthen policy and systems.
However, many of those goals could not be reached without sufficient
support.

To that end, he underscored the
need for sustainable funding mechanisms, particularly at the global level, where
an “NCD” fund similar to the Global Fund for AIDS, Tuberculosis and Malaria
would be helpful. Because it would be impossible to address non-communicable
diseases without development partnerships, national partnerships with regional
organizations were also necessary. Fiji was willing to work with all Member
States to implement the Political Declaration, but believed the imperative of
addressing non-communicable diseases was not limited to a meeting to exchange
ideas and experiences. Rather, an approach that encouraged the whole of society
and Government was essential. In addition, a more global approach was needed to
supplement the groundwork currently under way in struggling island nations. The
international community must also go further in linking goals to specific
targets. Developing nations must also be supported in building the capacity of
their health systems and in strengthening infrastructure and human resource
development.

MOHAMED WAHEED, Vice-President of
Maldives, stressed that the first key action for success in combating
non-communicable diseases was strong and sustained political leadership at the
highest level. The top priority of the current meeting, therefore, should be to
strengthen political resolve for the accelerated implementation of all aspects
of the WHO Framework Convention on Tobacco Control and other methods for
achieving a world free of tobacco. Primary care and access to cost-effective
preventive measures needed greater focus. Prevention of non-communicable
diseases was also inextricably linked with climate change and the need for
low-carbon policies, which Maldives continued to highlight globally.

Furthermore, he advocated regular
monitoring of progress based on targets for prevention and control of those
diseases, as well as accountability at the national, regional and global
levels. The country’s 200 scattered islands of the Indian Ocean had
successfully eradicated polio, malaria and many other childhood illnesses, and
had recently introduced “telemedicine” in about 40 islands in order to promote
early detection and treatment. Among other efforts, Maldives was redesigning
its urban areas to create national recreation areas. The global community
should not lose the opportunity presented today, but should achieve the goal of
avoiding premature deaths and disability from non-communicable diseases, thereby
improving global health for years to come.

CISSÉ MARIAM KAÏDAMA SIDIBÉ, Prime
Minister of Mali, said there had been extraordinary growth in
non-communicable diseases in the world and particularly in Africa, with the
emergence of cancer, diabetes and chronic respiratory disease due to pesticides
found in the food chain. The epidemiology of those chronic diseases had been
known for a long time and Mali recognized the gravity of the impacts of those
ailments on the poor. Non-communicable diseases were increasingly becoming an
issue for the developing world and warranted international attention. However,
developing nations did not have the means to provide oversight, and she called
for international solidarity in that regard.

Citing WHO morbidity and mortality
rates that would increase over time, she commended the adoption of the
declaration on non-communicable diseases, which she called a “major step” in
halting their advance. Fighting illnesses that had a social impact was a
priority, which was why Mali provided free cancer treatment, as well as free
access to surgery and radiotherapy. Also, by the end of the year, the
Government would adopt a national prevention strategy to fight non-communicable
diseases. In closing, she called for a global multisectoral programme to fight
non-communicable diseases under the auspices of the United Nations.

SALOMÓN NGUEMA OWONO, Deputy Prime
Minister and Minister for Health and Social Welfare of Equatorial Guinea,
said that non-communicable diseases were a major health-care challenge for
African countries, where the situation was rapidly worsening. Recognizing and
addressing the threat was one of the greatest development challenges of current
times and the world was at a crossroads. The world strategy for combating
non-communicable diseases was first developed in 2000 by WHO, with subsequent
resolutions, strategies and programmes subsequently elaborated and adopted. He
cited among those the recent adoption in April of the Brazzaville Declaration on
Non-Communicable Diseases, at the first Africa Regional Ministerial Consultation
on those ailments.

He went on to say that while
non-communicable diseases were still not documented properly in Equatorial
Guinea, they were targeted in the country’s specific objectives to reduce
morbidity and mortality rates. The Government was very pleased with the recent
national health-care survey and hoped that the results would not only be
reliable, but would lead to the elaboration of relevant health-care policies.
Other national efforts aimed to reduce inequalities in care and to increase the
availability of potable water in urban areas. Overall, policies were needed to
reduce the burden of non-communicable diseases on health-care systems. To that
end, all available resources must be mobilized. It was not enough to start with
good resolutions; their concrete implementation was required to save millions of
lives currently in jeopardy.

Princess GHIDA TALAL of
Jordan, who was also the Special Envoy of His Majesty King Abdullah II
and Chairperson of the King Hussein Cancer Foundation, said that
non-communicable diseases claimed the lives of 36 million people annually. “Why
is the world community allowing these culprits to hold our world hostage?” she
asked. Urgent action was needed. The four “plagues” of the main
non-communicable diseases — once belonging to the developed world — had migrated
to the developing world, which was already crippled by a lack of infrastructure
and resources. Developing countries struggled with all kinds of shortages; the
burden of non-communicable diseases was especially heavy there.

Sharing one success story, she
recounted that the cancer treatment landscape in Jordan had been “very bleak”
just a decade ago. Only a “privileged few” had had access to cancer treatment,
and she herself had been among those lucky enough to access treatment for her
husband when he was diagnosed with cancer. “Did other wives not share my fears
about their children and husbands?” she asked. “Of course they did.” She said
that the cancer centre that she represented, which was unique in the Middle East
region, had poured all of its efforts into providing life-saving treatment to
its patients, believing that if no treatment options were available, screening
measures would not be of interest to anyone.

Only once a course of treatment
had been established did the Foundation begin to target the issues of early
detection prevention, she continued, urging everyone present today to take
immediate action. “It is not a choice or an option, a whim or a luxury”, she
stressed. Further, the world community must dedicate a global fund to help
developing countries implement their national non-communicable diseases plans.
Wasn’t the figure of 350 million people dying in the next decade frightening
enough? she asked. It was the obligation of everyone present today to act, in
the name of justice and equality.

First Lady of Chile CECILIA
MOREL said that the twenty-first century had brought unprecedented health
challenges, and the epidemic of non-communicable diseases was undermining the
improvement in well-being and the reduction of inequality among the world’s
nations. Chile was experiencing a sharp increase in both chronic diseases and
their risk factors, mostly impacting women and those most vulnerable. Chile,
therefore, would focus in 2011-2020 on improving lifestyles, controlling risk
factors, and stressing prevention in order to provide care for the sick and make
sure that the healthy stayed healthy.

Today, she said, medical matters
were no longer the purview of the health sector alone, but required
inter-sectoral work in such fields as education, housing, agriculture and
others. It was essential, therefore, that both public and private agencies were
involved in efforts to build a new health culture. The president of Chile would
personally lead the crusade and establish a mandate comprising specific tasks,
financing and coordination. Those efforts would be called elige vivir
sano, or “choose to live healthy”, and would motivate citizens to make four
commitments to improve their quality of life: eat healthily, engage in physical
exercise, and enjoy family and outdoor activities. Targets had also been
adopted to reduce smoking, obesity, sedentary lifestyles, and excessive alcohol
consumption, in order to control diabetes and high blood pressure.

JOHN DALLI, European Commissioner
for Health and Consumer Policy of the European Union, said stimulating
action to prevent and control non-communicable diseases could lead to enormous
gains in improving health and socio-economic development worldwide. The
enjoyment of the highest attainable standard of health was a fundamental right.
Indeed, the burden of non-communicable diseases and the loss of human potential
negatively impacted development. But a great deal of that burden was
preventable by addressing tobacco use, diet, physical activity and harmful
alcohol consumption, as well as the underlying social and environmental
determinants.

To achieve results, he emphasized
the importance of integrating national commitments for the prevention and
control of non-communicable diseases into health systems. He welcomed the
Political Declaration, especially its emphasis on WHO’s leadership and the need
for strengthened awareness to deal with the health determinants of
non-communicable diseases, with the aim of eliminating inequalities. Outlining
measures taken by the Union, including its ratification of the Framework
Convention on Tobacco Control, he said food reformulation also was high on the
agenda, notably through strategies to reduce salt, trans-fats and sugars. In
sum, the Union looked forward to working with WHO and relevant United Nations
agencies to implement actions defined in the Declaration and in considering what
other work should be carried out.

XAVIER BERTRAND, Minister for
Labour, Employment and Health of France, underlining the major challenges
of non-communicable diseases, stressed that no health-care system today could
overlook them. Combating them required greater awareness of their risks,
changes in behaviour and more binding measures to limit the factors contributing
to them. Non-communicable diseases clearly had many causes, including sedentary
lifestyles and unbalanced diets, and health-care responses were not enough.
Rather, those diseases must be prevented. For example, to combat obesity,
Governments should educate their citizens to change their behaviour, exercise
and modify their diets. France’s National Programme for Nutritional Health took
that approach.

Reiterating that binding measures
were needed to change behaviours, he said that applied equally to producers,
citing in that context several WHO initiatives to limit sugar and control
tobacco. While it was clear that everything was important in health care —
including food security and communicable diseases — non-communicable diseases
must be at the heart of the agenda, and while a signed convention was good, an
implemented convention was better. He stressed that as President of the G-20,
France wanted to improve the social protection network. The French Government
also believed that innovative financing must be considered to combat
non-communicable diseases. In that regard, he highlighted WHO’s suggestions for
a tax on tobacco producers and stressed that absent adequate financing, progress
could not be made to reduce non-communicable diseases.

JORGE VENEGAS, Minister of Public
Health of Uruguay, speaking on behalf of the Únion de Naciones
Sudamericanas (UNASUR), stressed that non-communicable diseases comprised a
global epidemic. The UNASUR countries were watching the process of
globalization — which was causing an increase in the number of those diseases —
with concern. Additionally, due to patterns of urbanization, people were
exercising less, while the consumption of fast foods was rising. Typically,
less developed countries had unreliable access to needed medicines. The UNASUR
countries considered access to medicines to be central in the right to health.
Health was, therefore, considered above trade interests, he said, underlining
the need to enhance access to drugs without any limitations for specific
diseases. In that context, he noted the lessons learned from the TRIPs Accord
and the WHO Global Strategy and Plan of Action on Public Health, Innovation and
Intellectual Property.

Other areas where Government
policies could be leveraged to cut rates of non-communicable diseases were
prohibiting the advertising of unhealthy food and drinks and reducing alcohol
consumption, he said. Further, the Millennium Development Goals had shown that
when there were clear, delimited and simple goals, alliances were more likely
for global health. Therefore, the current meeting was vital and should result
in specific global, regional and national goals regarding non-communicable
diseases.

MARTY M. NATALEGAWA, Minister for
Foreign Affairs of Indonesia, speaking on behalf of the Association of
Southeast Asian Nations (ASEAN), said non-communicable diseases were affecting
mostly working-age adults, eroding the most productive generation in the world
today, thus reducing the gross domestic product of low to middle-income
countries by as much as 5 per cent. “This is one reason why poverty is so
wide-spread,” he said. “In our view, prevention is the key to resolving it.
Prevention is and will be our priority.” ASEAN was developing referral systems
and improving surveillance systems, while working toward universal health
coverage and providing services for people with chronic non-communicable
diseases. It was also accelerating tobacco control programmes, promoting a
smoke-free environment and aligning national policies on agriculture, trade,
industry and transport to improve diets, encourage physical exercise and reduce
harmful alcohol use.

ASEAN was implementing
community-based intervention for early detection of factors for major
non-communicable diseases, but the need for international cooperation for public
health could not be overemphasized, he said. He urged development partners to
fund research on the unique public health problems of his region, calling on the
international community to help ensure essential pharmaceutical products and
medical devices were available. “In short, the partnership among countries is a
must. Among developed and developing countries. At the global, regional and
bilateral levels,” he said. ASEAN was also committed to enlisting participation
of civil society, the private sector and community organizations.

In Indonesia, non-communicable
diseases affect urban populations and also the rural poor, compounding the basic
problem of poverty, he said. A special unit at the Ministry of Health had been
tasked to strengthen non-communicable disease control. Indonesia had also given
priority to minimizing tobacco use, alcohol abuse, an unhealthy diet and
physical inactivity. It was committed to implementing the 2008-2013 Action Plan
for a global Strategy for the Prevention and Control of Non-communicable
Diseases, and hosted a regional meeting on health and development challenges of
non-communicable diseases in March, which produced significant recommendations
that had been offered as inputs for the outcome document of this meeting. He
added that “we will have to work hard as a family of nations to carry out what
we have declared”, including an extensive review of progress by 2014. “Finally,
we call on the international community to include progress in the fight against
non-communicable diseases as a component of the MDGs plus beyond 2015,” he
said.

CHEN ZHU, Minister of Health of
China, said that globalization had led to an unprecedented level of
interdependence among countries and “interwoven interests”. The prevention and
treatment of non-communicable diseases, therefore, related to “the common
development of all mankind”. In that light, China’s delegation made three
proposals. First, national health systems should be strengthened and health
should be integrated into all policies. Governments should attach as much
importance to health as to economic development, and should play a leading role
in creating a supportive policy environment, increasing financial input,
establishing multisectoral cooperation and coordination mechanisms and
mobilizing all circles of society in the prevention and treatment of
non-communicable diseases.

Second, international
collaboration should be enhanced on the basis of complementary advantages, he
said. Technical exchanges could be strengthened and experiences shared amongst
developing countries through South-South cooperation and among Brazil, the
Russian Federation, India and China. North-South dialogue should also continue
to expand the technical transfer and financial support from developed to
developing countries based on the needs of recipient countries. Third,
prevention and treatment activities should be aligned and coordinated, and the
global consensus should be deepened on prevention and control. More specific
goals and evaluation indicators for non-communicable diseases prevention and
treatment should be established, including a push for the inclusion of
non-communicable diseases prevention and treatment as a Millennium Development
Goals indicator.

As a large developing country,
China was on track “to get old before it gets rich”, he said. The rapid growth
of chronic diseases would lead to shortages in the healthy workforce, the
decline of life quality and an increased socio-economic burden. The Chinese
Government pursued a comprehensive, coordinated and sustainable “scientific
development concept”, he said. Health was the basis for all-around human
development and the guarantee for sustainable social development. In that vein,
the core of China’s health-care reform was to realize universal health coverage
for the country’s 1.3 billion people, he said, further detailing the elements of
the country’s national health policies. China was also sparing no efforts, he
said, in providing medical support to the developing world.

KATHLEEN SEBELIUS, Secretary of
Health and Human Services of the United States, said that when the
nations of the world came together they could show great improvements in public
health. Chronic diseases accounted for seven out of ten deaths in the United
States, and the administration of President Barack Obama has made taking them on
a major focus. Later this week, in the United States would announce a number of
public and private partnerships, including a Clinton Global Initiative to
promote a smoke-free workplace around the world. “In order to turn the tide on
chronic disease we must recruit partners from outside the government and outside
the health sector,” she said. People needed clean water and affordable food, and
governments must work with partners to attain that goal. The United States
welcomed the opportunity to learn from partners around the world, she
said.

MOHAMMAD HOSSEIN KIKMAN, Acting
Minister of Health in International Affairs of Iran, said today’s timely
high-level event provided an opportunity for the international community to
share experiences and come up with proposals to forge effective collaborative
partnerships to implement realistic health and development programmes regarding
non-communicable diseases. He said that the Eastern Mediterranean region was
suffering a heavy burden of such diseases and in Iran, the total burden was
45 per cent for males and 35 per cent for females. In addition, overweight and
obesity arterial hypertension and inadequate physical activity were among the
greatest risk factors. With that in mind, the Government had enacted its
National Millennium Development Goals Master Plan, as well as its Fifth National
Development Plan, which both included a series of programmes and initiatives
aimed at reducing the burden of non-communicable diseases.

Specifically, the programmes
targeted the risk factors of those diseases with prevention and control
measures, through, for example, imposed taxes to curtail unhealthy habits, such
as tobacco use. They also involved massive public information campaigns,
initiatives on food industry regulations and screening for high blood pressure
and glucosemia. He went on to say that Iran’s national cardiovascular disease
control programme focused on reaching rural areas, and the National Cancer
Control Programme focused on colorectal and breast cancers.

ANDREW LANSLEY, Minister of Health
of the United Kingdom, said the world had come together more than half a
century ago to combat infectious diseases and, in subsequent decades, had begun
to tackle other infections such as malaria and HIV. While that fight must go on,
it now faced new challenges posed by non-communicable diseases, which were just
as widespread and chronic and increasingly threatening mortality and
disability. Those diseases were associated with lifestyles and environments and
were often avoidable. While previously thought of as diseases of relative
affluence, they could, in societies where development brought opportunity,
affect the poorest and kill millions each year. Moreover, their combined
financial weight threatened to crush countries’ respective health-care systems.

“We need to act with boldness and
determination,” he said, calling for a “whole-Government” approach that aligned
the objectives of national and local Governments, as well as of health-care
providers, behind a simple set of measurable outcomes. The United Kingdom’s
strategy was based on a single outcomes framework, which emphasized prevention;
sought to make the environment healthier; gave health-care professionals and
local communities freedom and resources to achieve those outcomes; empowered
individuals to take charge of their own health; and brought all parts of civil
society, including industry, together to promote healthier lives. While
regulation and tax both played important roles, a free society could not simply
legislate those health problems out of existence. People and businesses must be
engaged, and the food and drinks industry should be seen, not just as part of
the problem, but part of the solution. Further, the healthy choice must not
just be the right choice, but the positive, easy and fun choice. An emphasis on
prevention, physical activity and personal and corporate responsibility could,
alongside unified Government action, make a big difference.

OULD ABBES, Minister for Health,
Population and Hospital Reform of Algeria , said the high-level meeting
was particularly timely due to the increase in the incidence of non-communicable
diseases and the pressure that growth was putting on health-care systems.
Diabetes, chronic diseases, cancers and other chronic illnesses were the top
killers in his country and, in response, the Government had put in place a
national strategy that involved relevant agencies, as well as civil society.
Algeria also adhered to the African Union strategy on combating the diseases and
was preparing to launch an innovative strategy over the next two years to help
bring the increase of non-communicable diseases under control.

He said Algeria was also
undertaking great efforts to bolster its national battle against all forms of
cancer, including through opening more and more treatment centres and providing
free treatments for all cancer patients, including chemotherapy. Looking ahead,
he urged the international community to focus on ensuring access by developing
countries to the drugs and treatment necessary to combat non-communicable
diseases. The poorest among us, who lived on $100 a month, would never be able
to afford the necessary cancer treatments. No nation had the moral right to
deny any human being a dignified way of life, he stressed.

YERZHAN KAZYKHANOV, Minister of
Foreign Affairs of Kazakhstan, said that improving quality of life for
individuals was not only a goal in itself, but also contributed to social
development and the achievement of the Millennium Development Goals. The
growing trend of premature mortality from chronic, non-communicable diseases
seriously impeded sustainable development and should be made a global priority.
He supported the Secretary-General’s recommendations, calling for a holistic
approach to removing risk factors, as well as international cooperation and
exchange of experience. The cost of dealing with the effects of
non-communicable diseases far exceeded the cost of prevention, and Kazakhstan
supported the efforts of WHO, whose scientific research and data collection had
helped to significantly raise the standard of control for such diseases. A
wider scope and higher quality of medical and sanitary measures to remove the
risk factors in public health care was most effective for lowering
incidence.

He encouraged WHO and the United
Nations Children’s Fund (UNICEF) to continue to develop the principles laid down
in the 1978 Almaty Declaration on Primary Health Care. Primary medical and
sanitary help, as mentioned in that text, remained the best model for providing
comprehensive services. Kazakhstan would continue strengthening its health-care
system, controlling tobacco products, and lowering excessive alcohol
consumption. The country had successfully implemented the WHO Framework
Convention on Tobacco Control, adopted the Code on Health and Health Care, and
launched a national programme to promote healthy lifestyles. A unified national
health-care system would be introduced in 2013, providing a new model of
financing for guaranteed free and results-oriented medical help.

MWAI KIBAKI, President of
Kenya, said that non-communicable diseases were a major health concern in
Kenya and responsible for more than 50 per cent of all hospital admissions and
deaths. Heart disease was responsible for more than 13 per cent of overall
mortality in the country, while cancer and diabetes contributed 7 and 4 per
cent, respectively. To address the growing burden of non-communicable diseases,
Kenya had established 45 diabetes comprehensive-care clinics and trained more
than 3,000 medical practitioners on the management and prevention of diseases.
Other preventive actions included those anchored in legislative frameworks, such
as the Tobacco Control Act which banned smoking in all public places, and the
Alcoholic Drink Control Act which regulated production, sale and consumption of
alcoholic drinks.

He said, however, that Kenya’s
resources were limited, and effective technologies were still out of reach for
many developing countries. He thus encouraged the establishment of partnerships
and international collaborations to facilitate the transfer of appropriate and
affordable technology. The cost of certain essential treatments and medicines
remained beyond the reach of most Kenyan patients. That enormous challenge must
be addressed through measures such as the TRIPS Agreement, in order to enable
the manufacture of needed medicines and related products and access to
them.

JEAN ASSELBORN, Deputy Prime
Minister of Luxembourg, aligning himself with the European Union, said
non-communicable diseases struck a double blow to socioeconomic development by
provoking a dramatic loss of national revenues and dragging millions of people
below the poverty line. Since they affected all countries, the response must be
global and universal, and required unequalled political commitment. It also was
important to take full advantage of — and deepen — the work done under the
leadership of WHO. The approach must first stress prevention and promote
“health in all policies”, including in the areas of health, agriculture,
education, sports, environment, trade and industry.

Continuing, he said sustainable
health systems must be established by ensuring continued financing, good
governance, adequate training for medical personnel, universal health insurance
and access to essential medicines. “These are stringent requirements” he said.
For its part, Luxembourg had included non-communicable diseases in the health
sector strategy of its development cooperation policy and spent more than
11 per cent of official development assistance (ODA) on health. For years, the
country had helped to strengthen health systems in its partner countries,
including Laos and Senegal. The political declaration just adopted by the
Assembly would ensure adequate follow-up in the years to come.

AARON MOTSOALEDI, Minister of
Health of South Africa, said non-communicable diseases should be regarded
as a development priority rather than only a health concern. A health-only
approach would not reverse global mortality and burden from non-communicable
diseases. Instead, a “whole of government” and “whole of society” approach was
needed. South Africa’s mortality rate had just about doubled over the last
decade, mainly as a result of HIV and AIDS. It was critical that, as global and
national priorities expanded, adequate attention was paid to prevention and
control over all diseases and towards achieving the Millennium Goals.

He said that South Africa had led
efforts on the implementation of tobacco control legislation and passed
regulations making the reporting of cancers compulsory. His country had also
passed regulations to reduce the use of trans-fats and was currently working on
regulations to reduce salt content in processed food. South Africa also
welcomed today’s Political Declaration; in order to achieve global targets,
effective partnerships should be established to increase prevention, screening
and treatment technologies, including affordable vaccines, diagnostics and
drugs.

To prevent non-communicable
diseases globally, he urged the international community to put pressure on the
food industry to reduce harmful foodstuffs and promote healthy eating habits
worldwide and on the alcohol industry to reduce the harmful effects of alcohol
by, for example, ceasing to advertise what was, for many, a highly dangerous
product. All partners should collaborate to realize a tobacco-free world.
Reducing non-communicable diseases required attention to several broad social,
economic and behaviour determinants of health involving many sectors. Tackling
both communicable and non-communicable diseases in an integrated, comprehensive
manner was fundamental to both improved health and development.

AGNES BINAGWAHO, Minister of
Health of Rwanda, said this summit was “a cornerstone of the health of
our global population”. A decade ago, in the same room, another summit opened
the way for universal access to treatment for HIV-positive people. Now, the
importance of targeting non-communicable diseases could not be ignored as
contributors to mortality and morbidity in Africa. Rwanda had made progress on
communicable diseases. In one year, for example, it had reduced mortality by
over 32 per cent and could now treat HIV as a chronic disease. Such successes
would help build programmes to fight non-communicable diseases.

She said that research in Rwanda
on prevention was planned for next year, but non-communicable diseases were
already known to account for approximately 25 per cent of the country’s disease
burden. Unless that problem was tackled seriously, a significant gap would
remain in health care, and Rwanda would never achieve development. Most endured
non-communicable diseases because they could not pay for treatment. That had
previously been the case with HIV, malaria and tuberculosis. But, Rwanda had
created several departments to coordinate the fight against non-communicable
diseases, used tobacco taxes to fund the welfare of its population and started
services to detect and fight cancer. “This is the beginning — we want to go
further,” she said. Universal medical access for those with communicable
diseases was promising, and global solidarity could contribute much.

LESLIE RAMSAMMY, Minister of
Health of Guyana, said that the adoption of the Declaration today meant
that non-communicable diseases now assumed a place of prominence “as a global
threat that needs to be addressed urgently”. Non-communicable diseases
comprised a new front in the fight to promote global public health and to
counter poverty. Guyana had recognized at an early stage that the efficacy of
national efforts in that area needed to be complemented by regional and global
level actions, and had been calling since 2001 for an “MDG+” dealing with
non-communicable diseases, as well as making the theme the focus of the
sixty-sixthsession of the General Assembly. The summit’s convening “was not
accidental”; it related instead to the gravity of the challenge.

He said that the Declaration
contained many measures that would help to combat non-communicable diseases, and
he called for its full implementation by all Member States. He underlined the
need for greater access to quality medicines, palliative and rehabilitative
measures at the community levels and the provision of increased and sustained
human and technical resources from all sources, among other elements. He also
urged Member States to develop national plans on non-communicable diseases by
2013 and to create indicators — including the reduction of preventable deaths
from non-communicable diseases by 25 per cent by 2025.

Guyana supported the appointment
of an envoy or special representative on non-communicable diseases, he said.
Additionally, more emphasis should be placed on Millennium Development Goal 8,
indicator 8e and target 13 to meet the need for better access to affordable,
quality medicines, technology and diagnostics. Also needed was more robust
implementation of WHO’s tobacco control strategy and the Global Strategy on
Diet, Physical Activity and Health for the Prevention and Control of
non-communicable diseases (2004). He also encouraged worldwide celebration of
Caribbean Wellness Day to commit citizens around the globe to the “wellness
revolution”.

NICOLA ROXON, Minister for Health
and Ageing of Australia, said non-communicable diseases posed a growing
threat to national health systems and economies, and they particularly
imperilled disadvantaged societies, further entrenching poverty and other
development ills. “So we must act now, or too many people will continue to
suffer from diseases that are largely preventable and our health systems won’t
cope,” she said, adding that her Government was strongly committed to action to
turn the tide on non-communicable diseases, at home and abroad. To that end,
Australia had pushed chronic disease prevention and the strengthening of the
country’s health sphere to the top of its health-care reform agenda. Australia
was also taking action on a range of other fronts, including research and social
marketing campaigns and providing support for preventive health
measures.

She was pleased to announce that
at the global level, Australia would provide a further $A 4 million towards
implementation of WHO’s Action Plan for the Global Strategy for the Prevention
and Control of Non-Communicable Diseases. That was part of some $A 4 billion in
health assistance targeted for developing countries over the next five years.
Finally, she recalled that Australia had long had tough tobacco rules in place.
It was taking another strong step next year by requiring that all tobacco
products sold within the country be packaged in the same unattractive brown
wrapper and covered almost entirely with graphic warnings. “Big Tobacco” was
desperately fighting that move, even threatening legal action against the
Australian Government. “But the more [they] fight, the more we know we’re on
the right track,” she said, and while taking on the big tobacco companies would
require lots of money and political will, the investment towards improved
national and global health “will pay huge dividends”.

JOHN SEAKGOSING, Minister of
Health for Botswana, said that non-communicable diseases, namely
cardiovascular diseases, diabetes, cancers and chronic respiratory diseases,
accounted for 60 per cent of global deaths, of which 80 per cent occurred in
developing countries due to such behaviours as smoking and excessive alcohol
consumption. The international community should not be discouraged, however, as
a tremendous impact could be made by implementing a comprehensive approach to
improve knowledge and awareness, and reformulate policies, laws and regulations
that governed behaviours, as well as by mounting a health-care system that could
adequately detect and monitor those diseases.

He said that while Botswana was
viewed as a middle-income country, it was necessary to ensure that its progress
was not reversed by the rising tide of non-communicable diseases, for which
resources needed to be increased at national, regional and international
levels. In Botswana, there were still high rates of morbidity and mortality
from communicable diseases. That should not be ignored. Instead, past
successes should be built upon and coordination increased at the highest levels
of government towards greater ownership and sustainability. The world could no
longer ignore the significance of non-communicable diseases and their impact on
the global population. To address public health crises effectively, he
challenged all those present today to set a bold course for the future and face
the problem head on. Botswana was implementing legislation to control excessive
alcohol use, and intended to take a hard look at the levels of sodium in the
food supply. The international community must not be deterred or swayed by
competing priorities; it must chart a successful course for the future.

JOSEPH YIELEH CHIREH, Minister for
Health of Ghana, associating his statement with that made on behalf of
the Group of 77 and China, said that the epidemiological transition in Ghana had
brought about a “double burden” of disease — communicable and non-communicable.
There was a steady decrease in infant and adult mortality and as life expectancy
rose and the population aged the most common problem was a new surge of
non-communicable diseases. In addition, recent changes in diet, the social
environment and the adoption of unhealthy lifestyles had added to the
problem.

He said that non-communicable
diseases were a barrier to the realization of development goals and were eroding
the gains spurred by poverty reduction strategies in developing countries.
Aside from those diseases commonly encountered worldwide, West and Central
Africa was faced with the challenge of combating sickle-cell anaemia, which
affected approximately 2 per cent of children in the neonatal age range. As
many as 90 per cent of them died before reaching the age of 5, as they did not
receive any care. Ghana was also working to bring down the disease burden
related to the four main global non-communicable diseases — cardiovascular
disease, diabetes, cancers and respiratory illnesses — by promoting healthy
lifestyles and applying measures aimed at curtailing risky behaviours.

Ghana had put several key measures
in place to counter the risk factors, he said. Those included: a national
policy on non-communicable diseases; a public health bill — now before
Parliament — with tobacco control as an integral component; a national strategy
for cancer control; a national sickle-cell strategic plan; and a regenerative
health and nutrition strategic plan. Ghana urged WHO to provide much-needed
technical assistance and direction in helping developing countries combat
non-communicable diseases, and urged development partners to provide support in
strengthening health systems and scaling up access to affordable essential
medicines.

HEINZ FISCHER, President of
Austria, said successfully tackling non-communicable diseases must
involve a host of Government sectors and cut across a range of public policies.
In Austria, that meant setting out 10 comprehensive and measurable health
objectives for the coming 20 years, all of which were the subject of a
structured political dialogue being led by the Health Minister and involving a
wide range of Government and non-government actors. Chronic diseases were on
the rise throughout Europe, largely due to unhealthy lifestyles. Like other
countries in the region, Austria was facing such challenges as obesity,
sedentary lifestyles, and smoking and alcohol consumption, especially among
youth.

In response, he said, the Health
Ministry had launched a Nutrition Action Plan. It followed a horizontal “health
in all policies” strategy, including measures that targeted nurseries,
kindergartens and other educational levels, in areas such as school catering.
The Sports Minister, working with other ministers, was developing an action plan
for physical activity. Based on up-to-date scientific information, that plan’s
recommendations would establish how much physical activity was necessary to
positively impact health according to age group. Austria’s health policy
focused on prevention, as well as on psychosocial factors and influences on
mental health.

URMAS PAET, Minister of Foreign
Affairs of Estonia, associating with the statement of the European Union,
said the global population would reach 7 billion in October, but world
demographics were changing in opposite directions. In Europe, societies were
ageing, and years lived in good health could be further extended. But the
number of young people in the world had never been higher and most of them lived
in the developing world. “Non-communicable diseases have particularly strong
socio-economic impacts on developing countries and are also greatly affecting
the achievement of the Millennium Development Goals, which, as we know, are
falling short of the targets in many countries,” he said. Estonia had increased
support of health systems in developing countries and continued to back United
Nations agencies as they improved access to health care, particularly for girls
and women, throughout the world.

“We know that the work to address
non-communicable diseases must be comprehensive and consistent and it takes time
to see first results,” he said. The necessary systematic approach was well
captured in the WHO European region charter titled “Health systems for health
and wealth”, also known as the Tallinn Charter. Over the past 10 years, Estonia
had seen a decline in premature mortality due to non-communicable diseases, but
it still remained much higher than in most European countries. There had also
been an alarming rise in the prevalence of obesity. “I am content that we have
agreed today to strengthen work on food marketing, reduction of salt and sugar
in food, as well as tackling alcohol abuse,” he said.

JUMA DUNI HAJI, Minister of Health
of United Republic of Tanzania, welcomed the opportunity to discuss
non-communicable diseases, which had become a major challenge to the current
health system. The prevalence of tobacco smoking in his country was 10 per cent
and the prevalence of those who were overweight was 21 per cent. Raised blood
glucose rates and rates of alcohol consumption were also high, and the
prevalence of diabetes was 5 per cent. The cancer rate was approximately 21.2
cases per 100,000 people, with cervical cancer representing the most common
kind. In addition, thousands of children were born in his country each year
with sickle-cell anaemia.

Further, he continued, the cost of
care for non-communicable diseases was very high, with most people who suffered
from such diseases spending more than 40 per cent of their income on care.
“Non-communicable diseases impoverish families,” he stressed. They must,
therefore, be included on the international development agenda. His country had
a national non-communicable disease strategy, which it had launched in 2009,
aiming to ensure access to health care and prevention. It had also established
a Government ministry to provide oversight in that respect. However, as the
country faced the “double burden” of both communicable and non-communicable
diseases, a focus on one type of illness should not jeopardize a continued
emphasis on the other.

HEIDI HAUTALA, Minister for
International Development of Finland, said non-communicable diseases were
a growing problem in the developing world, alongside the challenges of meeting
Millennium Goals. Developed countries did not provide a good example, as their
lifestyles were closely linked to many of those diseases. However, those
countries had accumulated much experience on how to tackle the diseases, and
that included Finland’s own work to prevent coronary and heart diseases.
Various factors affected health, including many outside the health sector, such
as agricultural policy, trade and urban planning. Schools and health education
were central to combating the problem of disease, which required a comprehensive
health approach in all policies. Gender issues also were central, as women
often suffered most from the effects of poverty and illness. However, women
were also powerful agents of change and their well-being affected society as a
whole. Poverty eradication and sustainable development were also directly
related to health and were important areas to address.

She said that while the primary
responsibility for addressing those challenges rested within each country,
development aid could have a catalytic role and international cooperation was
also needed. Finland, despite financially challenging times, had increased is
official development assistance (ODA). The role of civil society in health
promotion was also crucial. The world must also continue to tackle communicable
diseases, such as AIDS, which was an enormous concern to the poorest countries.
The United Nations as a whole had a core role to play in promoting sustainable
development and the achievement of the Millennium Goals, including in the area
of health. It was crucial to advance United Nations reforms to ensure that the
Organization could respond successfully to the present challenges.

YASMINA BADDOU, Minister of Health
of Morocco, said efforts were needed to combat non-communicable diseases
through an integrated multisectoral and multidisciplinary strategy based
primarily on a preventive approach to reduce risk factors and promote healthy
lifestyles, early detection and the implementation of an appropriate regulatory
and fiscal framework. It was urgently necessary to consolidate the mechanism of
international cooperation and assistance for developing countries so they could
develop their health systems, build capacity and benefit from successful
experiences in non-communicable disease prevention and control.

She said her country was committed
to the international fight against those diseases, endorsed the WHO 2008-2013
Action Plan and welcomed consensus on that document. Morocco was also committed
to implementing WHO’s strategic directions through a national plan based on the
integration of prevention and control. National efforts had strengthened in
recent years through partnerships and social mobilization. In addition,
national plans had been set up for prevention of diabetes, cardiovascular and
respiratory diseases to reduce morbidity. Morocco proposed that the feasibility
be examined of creating a voluntary sustainable fund to fight non-communicable
diseases, which could facilitate the implementation of the Political
Declaration. Such a fund would assist developing countries in facing the
challenges and implementing the commitments made.

JAMES REILLY, Minister of Health
of Ireland, quoted a common Irish saying that “health is better than
wealth”. In fact, health was not just an individual issue, but one affecting
the productivity and well-being of nations. It was easy to attribute the
achievement of increased longevity in places like Ireland to medical advances,
but a substantial chunk of that was due to vaccinations, safer living
conditions, and other preventions. It would be safe to assume that the next
major development in health would be along the same lines.

He said “the creeping catastrophe”
of non-communicable diseases now accounted for two out of three deaths
worldwide. The Irish health system as it stood would simply not be able to
withstand the burden of non-communicable diseases if their rate continued to
increase. A major emphasis on prevention was essential, including the country
working to reform its health system and ensure treatment and access for all.
“Prevention is always better than cure,” he said, but added that cure was what
garnered headlines. Caring for patients at the lowest and most local level was
Ireland’s strategy. For example, the country had been a leader in banning
smoking in the workplace. Public health statistics were changing due to that
decision, and the lesson should be applied to areas such as alcohol use and
lifestyle. “The health of our people comes first,” he said, adding that today’s
Declaration was a significant contribution to that aim.

LIOW TIONG LAI, Minister of Health
of Malaysia, recalling his country’s implementation of a national
strategic plan for non-communicable diseases since 2010, said that to support a
“whole-of-Government” approach to combating those diseases, a Cabinet Committee
for a Health Promoting Environment had been formed and was chaired by the Deputy
Prime Minister. Commitments made at the high-level meeting would provide a
strong advocacy tool that Malaysia would use to gather support of all related
ministries and agencies to move the agenda forward. The Malaysian Health
Promotion Board would be used to increase the capacity of non-governmental
organizations to play a more proactive role in community-based non-communicable
disease risk interventions.

“World leaders must act
immediately and responsibly to deliver key changes in the political
declaration,” he said, stressing the importance of setting clear, measurable and
time-bound targets. He proposed that the indicators presented by WHO in
April 2011 be incorporated into the political declaration. Recalling that the
United Nations Declaration on HIV/AIDS had endorsed the use of “flexibilities”
guaranteed by WTO TRIPS to ensure trade did not violate patients’ rights, he
said Malaysia did not want the introduction of new generic drugs to be
obstructed by conflicting interpretations of national legislation on TRIPS.
Many countries were challenged to provide access to essential medicines to
manage non-communicable diseases and, for Malaysia, generic drugs were essential
to delivering health care to its people.

SIMON POWER, Minister of Justice
of New Zealand, said that death and disability from non-communicable
diseases had reached epidemic proportions, pushing poor people further into
poverty and impeding the achievement of the Millennium Development Goals. New
Zealand was confronting the magnitude of the problem not only for its own
people, but for those living in its Pacific Island country neighbours, where
over 40 per cent of the adult population suffered from diabetes. With this
number set to double by 2030, non-communicable diseases were having a massive
impact on their potential for social and economic development.

The Pacific Islands region was
already struggling to meet the 2015 Millennium Development Goals targets, and
rapidly rising expenditure on non-communicable diseases now comprised over
50 per cent of total health budget for many island countries. Left unabated,
non-communicable diseases could undermine the four main factors driving economic
growth, namely labour supply, productivity, investment and education. Leaders
at the New Zealand-hosted Pacific Islands Forum called for quick and decisive
action from governments, the private sector, civil society and regional and
international organizations and development partners to address this rapidly
unfolding crisis. Non-communicable diseases were not just a health issue, but
required a whole-government approach, along with innovative strategies across
different sectors. Aiming for a “smoke-free” country by 2025, New Zealand would
substantially reduce non-communicable diseases, with considerable health
benefits for countries and individuals. He urged countries that had not yet
done so to become party to the WHO Framework Convention on Tobacco
Control.

FATIMA AL BALOSHI, Minister of
Health of Bahrain, said that her country had been able to eradicate
almost all childhood diseases through vaccination, it was working toward the
achievement of the Millennium Development Goals on health. It had reduced the
child mortality rate, she said, and had increased screening for those 19 to 65
years old. It had reduced the national diabetes rates, as well as the number of
those suffering from high cholesterol. However, the percentage of smokers in
Bahrain was just over 19 per cent. A new screening programme for 2015 was under
way, she said, and the issue of non-communicable diseases was inscribed on the
list of priority objectives through 2030.

Three major initiatives were under
way in an effort to strengthen the health system through prevention, early
screening, treatment and the promotion of healthier lifestyles, she said. The
health ministry had set up a committee on the prevention of non-communicable
diseases. It had adopted “paramount policies” on reducing the tobacco use
prevalence, in line with the Framework Convention on Tobacco Control. Bahrain
had also adopted a national strategy on diet and exercise. It was setting up
partnership initiatives all over the country, she added, including through
23 specialized clinics, with more planned for early screening. Bahrain was also
working on initiatives along with regional offices and through the Gulf
Council. Non-communicable diseases had a harmful impact on the development and
economies of countries, she added, saying that she wished, therefore, to
underscore the importance of the content of the Declaration, and the importance
of building global capacity to address the “scourge” of non-communicable
diseases.

LEAO TALALELEI TUITAMA, Minister
of Health of Samoa, said that small islands countries like Samoa made up
the “blue continent” in the South Pacific, emanating from the vast surrounding
blue ocean. This region, while plentiful in areas such as fishery resources,
was also challenged by limited opportunities. In Samoa, younger groups were
increasingly affected by non-communicable diseases at an alarming rate. In
Samoa, 23 per cent of adults aged 25 years and above were diabetic, 21 per cent
were hypertensive, and obesity was an increasing risk. The direct link between
non-communicable diseases and the leading causes of morbidity and mortality in
Samoa were, therefore, clear and undisputed.

Over the past two decades, Samoa
had put in place legislature to minimize risk factors, such as through the Food
Bill 2011 aimed at controlling the inflow of cheap and non-nutritious “junk”
food, and by reviewing relevant policies to help Samoa with lifestyle issues.
The vicious circle of non-communicable diseases impeded the ability of small
island developing States to raise and sustain levels of social and economic
development. Managing non-communicable diseases within the national constraints
of Samoa’s health-care system was becoming increasingly expensive and may soon
be unsustainable, hence the commitment to promoting healthy lifestyles and
health protection at a national level. As 2011 was the year for
non-communicable diseases advocacy, a bilateral initiative was launched a month
ago between Samoa and American Samoa, resulting in a joint Non-Communicable
Diseases Prevention and Control Agreement to address the situation on both
nations islands.

Samoa was collaborating with many
Pacific island countries to revitalize the 1995 Ministerial Declaration on
Healthy Islands, which translated in practical terms an approach for healthy
lifestyles in communities, schools, market places, workplaces and churches.
Still, the road ahead was arduously long, challenging and overwhelming, since
many contributing factors were outside the control of the health sector. The
non-communicable diseases epidemic perpetuated poverty. Those most vulnerable
were voiceless victims of industrial trade and economic policies, which often
failed to include health and well-being concerns, focusing instead only on the
financial gain of a few, at the cost of the early and painful deaths of
many.

YAAKOV LITZAMAN, Deputy Minister
of Health of Israel, said that, like all countries in the world, his had
felt the devastating pain of non-communicable diseases, and wanted to be part of
the solution. “Studies have shown that the morbidity and mortality of
non-communicable diseases are not equal among all sectors of our society, which
includes citizens from over 90 countries. Therefore, we must strive to provide
the best possible service to all people within our society — whether they are
Jews, Muslims or Christians.” Israeli scientists had gained a reputation for
their cancer research, which was widely shared in international scientific
literature. Cutting-edge technologies for prevention, screening, diagnostics
and treatment of non-communicable diseases had been provided by its National
Health Insurance Law. Israel’s commitment to fighting non-communicable diseases
was also reflected in its wide-range of partnerships throughout the developing
world, he said.

The public needed to galvanize to
address the causes of these diseases. “We must promote better nutrition,
educate our people about the effects of alcohol and tobacco use, and work to
diminish environmental pollution,” he said. “As it is written in the holy Bible
— ‘these commandments are not in heaven.’ God has given us the opportunity to
lead our people, and especially our youth, to better health.” Israel looked
forward to working in collaboration with its neighbours and countries all over
the globe on this crucial issue.

SABYRBEK DJUMABEKOV, Minister of
Health of Kyrgyzstan, pointed to the rise in cardiovascular disease and
malignant tumours in Kyrgyzstan. Since 2000, the incidence of type 2 diabetes
had grown by 72 per cent. More than 500,000 people, or more than 20 per cent of
the population of Kyrgyzstan, suffered from high blood pressure. He stressed
the importance of strengthening international cooperation to prevent
non-communicable diseases. He lauded the merits of the joint international
research centre in which researchers from India, Kazakhstan and the Russian
Federation collaborated on programmes to prevent non-communicable diseases.
There were programmes under way to increase the quality of oncological
services.

He expressed worries about the
tobacco epidemic, which was spreading, particularly among youth in Kyrgyzstan,
and the high level of morbidity due to respiratory disease. The Kyrgyzstan
Government had implemented a national smoking prevention programme, as part of
its strategy to prevent cardiovascular disease. In view of the swift
proliferation of non-communicable diseases, it was timely to implement
prevention programmes, which could significantly impact people’s way of life.
He stressed the need to ensure a comprehensive approach to strengthen health
systems and to properly train all medical personnel. He called on all donor
partners to bolster measures to prevent non-communicable diseases.

LEONA AGLUKKAQ, Minister of Health
of Canada, said chronic diseases were the leading cause of death in her
country and the Government had placed a priority on prevention, as seen in its
endorsement last fall of a Declaration on Prevention and Promotion. While
individuals could make healthier choices to reduce their risks, promoting good
health was everyone’s business, which was why solutions should involve a broad
base of partners like non-governmental organizations, all levels of Government
and sectors that had a bearing on health.

Citing gains, she said Canada’s
smoking rate had dropped from 25 per cent in 1999 to 17 per cent today, an
historic low. But, the federal, provincial and territorial governments were
still concerned by rising rates of “overweight” and obesity, particularly among
children and youth. One in four children was affected and the present trends
must be reversed. In the area of mental illness, Canada was pleased that the
language in the Political Declaration recognized the links between mental and
neurological disorders and non-communicable diseases. “Prevention must be the
foundation for our action on [non-communicable diseases], both domestically and
internationally,” she concluded.

ANNE-GRETE STRØM-ERICHSEN,
Minister of Health and Care Services of Norway, stressed prevention as
key in the fight against non-communicable diseases and, if done right, it would
contribute to economic growth and reduce social inequalities in health within
and between countries. Governments must take the lead in the prevention
effort. Risk factors, such as tobacco and obesity, must be addressed, using
policy instruments at the population level. National health systems must also
be strengthened, but an effective strategy did not rest with the health sector
alone. Cross-sectoral action was needed to respond effectively. Also required
was the active involvement of sectors like urban planning, finance, industry,
trade, education, culture and agriculture. Careful attention must be paid to
the role of different stakeholders. Indeed, civil society organizations played
a crucial role in the fight against non-communicable diseases.

The world community knew from
experience that setting targets and goals were useful in order to achieve
progress, she said. In that regard, WHO had played a leading role and, through
it; targets, indicators and a monitoring framework should be developed for
countries to apply in their national settings. Stressing that the reduction of
tobacco consumption was one of the most efficient measures to prevent
non-communicable diseases, she noted that the tobacco industry had taken legal
action against a number of parties to the WHO Framework Convention on Tobacco
Control, including Norway. That was unacceptable, she said, underscoring that
no party to the framework convention should allow the tobacco industry to
intimidate them from fulfilling their legal obligations to protect public
health.

PHILIPPE COURARD, Secretary of
State for Social Integration and the Fight against Poverty of Belgium,
said it was crucial to rethink the role of the health sector and have a
visionary approach to that reform process. Health sectors were increasingly
burdensome and they must be reinforced. Primary care and primary care
practitioners must play an essential role in that progress. There must be a
multifaceted, forward-looking approach to primary care and access to
high-quality care must be guaranteed. Sick people must have a role and they
must receive the necessary care from all areas of the health-care sector. In
rich countries, low-income people were the most affected by non-communicable
diseases.

The increasing cost of treatment
for such diseases had been financially burdensome on low-income people, he
said. Many of them could not afford such costs. Health-care systems must be
integrated; people must not be marginalized. Combating inequality must be an
essential part of all health-care strategies. The focus must be on effective
interventions to make health care affordable and to implement new models of
health care, particularly in terms of community and primary care. He appealed
to all countries to commit to combating non-communicable disease and to adopting
health-care policies accordingly. He stressed the need to implement initiatives
for prevention and innovative health care that represented added value, taking
into account the experiences of patients and their doctors.

MAITHRIPALA SIRISENA, Minister of
Health of Sri Lanka, said four decades ago, her country’s average life
expectancy was 40 years. Today, it had nearly doubled, due to gains in maternal
and child health services, as well as the prevention and control of communicable
diseases. But non-communicable diseases were still a challenge, accounting for
more than 60 per cent of total deaths. Sri Lanka was committed to tackling them
by formulating a national policy and creating a control unit within the Ministry
of Health.

More broadly, she urged the
Assembly to create a global fund to prevent and control those ailments.
Thanking the international community for its assistance in rebuilding her
country, she said that, with political commitment, she was confident that Sri
Lanka would lead the region in implementing an effective, nation-wide programme
to combat non-communicable diseases. Sri Lanka aimed to reduce premature
mortality due to chronic non-communicable diseases by 2 per cent annually over
the next decade.

ARTURO BENDANA, Minister of Health
of Honduras, highlighted the risks of non-communicable diseases, such as
heart attack, stroke, diabetes and chronic obstructive pulmonary disease among
Hondurans, particularly women — 46 per cent of whom were overweight. He further
noted the increasing rates of renal diseases among the population of Honduras
and stressed the efforts the Government was taking to address that illness. The
State was also working to combat the underlying risk factors of non-communicable
diseases, he said. Among other things, it had enacted a National Tobacco Control
Law prohibiting smoking in all public spaces, and was working to ensure that the
law was observed throughout the country.

He went to say that, while
national standards already existed regarding mother and child care, Honduras was
working to formulate similar standards to address non-communicable diseases.
Noting rising health-care costs for households, he underlined the need for
Government policy to address the problem and highlighted a recent meeting on the
Central American health sector in that regard. He further stressed that healthy
lifestyles must be adopted. In addition, it was clear that the Government
strategies that aimed to achieve the Millennium Development Goals dovetailed
with those health responses that would reduce non-communicable diseases. These
included eradicating hunger, reducing infant mortality and reducing
tuberculosis, among others.

SLAHEDDINE SELLAMI, Minister for
Health of Tunisia, said today’s meeting was taking place in conjunction
with the Arab spring. He was fully committed to implementing at the national
level the goals set forth in the Summit’s declaration on preventing
non-communicable diseases. He stressed the importance of guaranteeing the right
to health for everyone at an institutional level and to meet people’s
socioeconomic needs, particularly in terms of health care. Tunisia was
undergoing a promising transition. The international community should not just
stand by and observe. It should support Tunisia’s transformation through
programmes and measures. Non-communicable diseases in Tunisia were a widespread
problem. According to numerous studies, they were proliferating rapidly. The
Tunisian Government was working to create an integrated, coordinated plan to
control non-communicable diseases.

He stressed the need for
prevention through changes in eating habits and lifestyles. Tunisia had
implemented WHO’s recommendations through a national food strategy and a
national sports strategy aimed at combating cancer and diabetes. Tunisia had
acquired great experience. Creation of a multilateral network for prevention
and control of non-communicable diseases was important and Tunisia was looking
at how to best promote it. It was necessary to mobilize human and material
resources and to assess the socioeconomic impact of non-communicable diseases,
while working to prevent early risk factors, such as tobacco consumption and
unhealthy lifestyles. He asked all developed countries and donors to take
measures to respond to developing countries.

ENRIQUE T. ONA, Secretary of the
Department of Health of the Philippines, said his country had, over the
past years, noted the global emergence of non-communicable diseases, as well as
a changed health profile for the country. Among the 10 leading causes of
mortality in the Philippines, seven were non-communicable diseases. Noting that
non-communicable diseases had also been linked to similar risk factors, such as
tobacco use, unhealthy diets and physical inactivity, among others, he said the
risk factors could all be modified, thus making those diseases and the resulting
premature deaths greatly preventable.

To that end, he said the
Philippines was fully committed to addressing the issues of lifestyle-related
non-communicable diseases; and that commitment was reflected in the country’s
Health Reform Agenda of Universal Health Care that was based on three thrusts to
achieve financial risk protection for all, improve access to quality health
services and focus on attaining the country’s Millennium Development Goals
through its campaign of “MDGmax”, which included non-communicable diseases.
Further, the country had developed a framework to strengthen the prevention and
control of lifestyle-related non-communicable diseases.

CHARLES SIGOTO, Minister of Health
of Solomon Islands, began by pointing out that his country’s location in
a disaster-prone region had been greatly impacted by climate change and had seen
increased frequency of droughts, floods, sea level rise and biodiversity,
triggering food and water security. Those disasters had pushed portions of the
population from their traditional ancestral land to urban centres relying more
and more on imported food. Those populations, in particular, became more
vulnerable to non-communicable diseases. Highlighting the urgency of the
situation, he said for Solomon Islands, time was of the essence, as the country
was a mere generation away from reaching the tipping point when managing
non-communicable diseases would become a challenge.

In that regard, prevention
remained the cornerstone of its policy, and had put in place its
Non-Communicable Disease Strategic Plan 2011-2015 to implement that strategy.
Additionally, his country was in the midst of developing a new strategy of
moving health resources and services to the rural areas, where 85 per cent of
its population resided. Noting the current huge disparity in health services
between rural and urban populations in Solomon Islands, he said the Government
was working to correct that and would be encouraging partner countries to invest
more in the health services in the informal sector. He believed a global effort
was needed to guarantee access to affordable, safe and effective quality
medicine, including diagnostic services with skilled manpower, to deliver on
health services.

SAMBUL LAMBAA, Minister of Health
of Mongolia, reported that, while heart disease and cancer were the
leading causes of death in his country, it had, in 2008, entered into a global
compact with the Millennium Challenge Corporation, which, among other things,
provided funding for the control of non-communicable diseases. That national
project had introduced early intervention initiatives and training programmes,
among others. The Government was particularly proud that it had significantly
raised its financial contribution to combating non-communicable diseases by
levying taxes on tobacco and alcohol.

He said that, while the pace of
death by most common non-communicable diseases had levelled off and early
detection had improved, tobacco use was nevertheless rising among key
populations, including mothers and youth. Alcohol consumption was also
contributing to early deaths among youth. Pointing to studies underlining the
links between alcohol use and poverty, he expressed Mongolia’s support for
controls for alcohol similar to those for tobacco. He also reiterated
Mongolia’s strong commitment to the WHO Global Strategy for the Prevention and
Control of Non-communicable Diseases. It was also fully committed to
implementing the Political Declaration adopted earlier in the day.

ONYEBUCHI CHUKWU, Minister for
Health, Nigeria, said sickle cell disease was a major challenge in
Nigeria; 150,000 babies in the country were born with the disease annually.
While prevention programmes were in place, those already suffering from the
disorder had the right to live and they must be treated. The Government had set
up a treatment centre in Lagos for that purpose, as part of national strategies
to achieve the third Millennium Development Goal. It had also set up four
special treatment centres to control the disease. At present, 8 million
Nigerians suffered from hypertension; 4 million had diabetes. The incidence of
chronic disease was high. He lauded the fact that trauma and injuries from road
traffic accidents had been included in the non-communicable diseases agenda,
noting that 10,000 Nigerians died annually from such accidents. International
cooperation was needed to address all factors contributing to road traffic
accidents.

Malnutrition was a culprit in
non-communicable diseases, he said. Fast-food caused high rates of
non-communicable diseases and obesity, and had led to chronic deficiencies
during pregnancy. Child malnutrition impaired mental development early on and
later in life. High sodium diets led to heart disease, causing economic losses
of $800 million annually in Nigeria. That figure was unacceptable. He
expressed hope that that the meeting would result in global commitments to
strengthen the international resolve to combat non-communicable diseases.
Development of the health-care sector was a critical part of the Nigerian
Government’s agenda to achieve the Millennium Development Goals.
Non-communicable diseases were not only controllable; they were also
preventable. Nigeria had taken mid-level steps to respond to the epidemic. It
had banned tobacco ads and the use of tobacco in public places since 1990. It
signed and ratified the WHO framework for tobacco prevention and control.
Nigeria’s National Assembly recently passed a national tobacco control law. The
fight against non-communicable diseases required global efforts for prevention
and control.

SREDOJE NOVIC, Minister of Civil
Affairs of Bosnia and Herzegovina, said his country had opted for a
multisectoral approach to improve health. The health of countries in Central
and Eastern Europe was undergoing a transition. Health changes in Bosnia and
Herzegovina stemmed from a transition in the socio-political system and were
seen in a declining birth rate and an increase in the number of people 65 years
old and over. Indeed, non-communicable diseases were the leading cause of death
in his country. A concern for equity and addressing the social determinants of
non-communicable diseases required a “whole of society” response, which closely
linked steps to integrate health into all policies and efforts to prevent
disease.

For its part, Bosnia and
Herzegovina chaired the South-Eastern Europe Health Network, he said, expressing
his appreciation to the United Nations and World Health Organization (WHO) for
their support. He also informed delegates that Bosnia and Herzegovina, in
cooperation with that Network, among others, would organize the Third Health
Ministers Forum in Banja Luka, on 13-14 October. The Forum would mark a decade
of actions in South-Eastern Europe and aimed at achieving both equity and
accountability in health. In sum, he said his country strongly supported the
synergy between existing health institutions and would work to strengthen the
collaborative network to support the full and effective implementation of
international health conventions and strategies.

NARAYAN SHRESTHA PRAKASH, Deputy
Prime Minister and Minister for Foreign Affairs of Nepal, said his
country had made significant progress in assessing the non-communicable diseases
situation in Nepal, as well as in formulating policies to address them.
Consumption of junk food, lack of physical exercise and environmental pollution
were on the rise in Nepal, as in other countries, which contributed to high risk
of non-communicable diseases. To combat such risk factors, Nepal was working to
improve laws and policies such as through the Alcohol Control Act, Tobacco
Control and Regulation Act, and Food Act, which were under implementation. The
Tobacco Act bans the sale of cigarettes to children under age 18 and to pregnant
women, and prohibits smoking in public places.

Nepal was also trying to set up a
surveillance system for non-communicable diseases, by incorporating
non-communicable disease data in the Health Management Information Systems.
Because treatments for cancer remained expensive, Nepal would provide free such
treatments for children, although it was necessary to explore various options
for health-care financing and social health protection, as such funding was
unsustainable. Raising awareness of risk factors for non-communicable diseases
was very effective, and such preventive measures would minimize catastrophic
health expenditure at the household level and lead to increased productivity.
Nepal was working closely with the WHO and other United Nations agencies,
development banks, and national and international organizations through a sector
wide approach in health, an approach proven to be very effective in achieving
progress for the Millennium Development Goals.

ANNETTE WIDMANN-MAUZ,
Parliamentary Secretary of State, Federal Ministry of Health, Germany,
said that in the next decade non-communicable diseases would become the most
common cause of death if there was no without swift action to prevent them. The
burden of the disease’s economic losses threatened future growth, particularly
in emerging economies. Wealthier countries had already faced the growing
challenges presented by non-communicable diseases in the past decade. Germany
had strongly focused on prevention for many years. An integrated approach that
focused on the population’s needs was essential. Internationally, Germany had
actively supported the WHO and its leadership and action to combat
non-communicable diseases. The WHO’s strategic approach had created powerful
instruments, including the framework convention on tobacco control and the
global strategy on diet and physical health, among others.

The general response to
non-communicable diseases included the creation of binding norms and efforts to
improve labour conditions, the environment and human rights, she said. Germany
was at the forefront of such efforts. Germany’s international development
cooperation policy included a focus on prevention and the underlying social
determinants of health, with emphasis on strengthening the health-care system
and on social protection mechanisms. There was still a long way to go, but the
goals were achievable with intensive international intersectoral cooperation.

RUDYARD SPENCER, Minister of Health of Jamaica, expressed disappointment that, while the Declaration
provided a good platform for ongoing consideration of the developmental and
other impacts of non-communicable diseases, it did not advocate more decisive
action for the international community to act together to save millions of the
52 million lives projected to be lost by 2030. Having recognized that there was
a global threat which had to be addressed urgently, the Declaration failed to
commit the international community to increased and sustained resources to
achieve that goal, he stated.

He pointed out that although
non-communicable diseases were a global challenge, they struck hardest at the
developing world and lower income populations; and strong evidence linked
poverty, lack of education and other determinants to non-communicable diseases
and their risk factors. Notwithstanding his disappointment with the
Declaration’s shortcomings, he acknowledged that some gains had been achieved,
and emphasized the need to scale-up the implementation of multisectoral,
cost-effective, population-wide interventions in order to reduce the impact of
the common non-communicable disease risk factors.Mr. FAWZI, Deputy Foreign Minister
of Egypt, lending support to the statement delivered on behalf of the Group of
77 and China, said that during past years, a number of Member States had taken
concrete steps to address non-communicable diseases at the national level.
Globally, 80 per cent of deaths from non-communicable diseases occurred in
developing countries. All people suffering from such diseases should be assured
access to effective preventive treatment and care by the year 2030. In that
endeavour, special attention must be given to strengthening national capacities,
especially in developing countries and African countries.

The international community must
work to enhance the abilities of every community to implement national awareness
campaigns to address harmful and unhealthy lifestyles, and strengthen national
capacities. He expressed belief in the importance of strengthening regional and
national capacities to prevent the spread of non-communicable diseases, through
efforts of the WHO and relevant international and regional bodies. The
international community had a special responsibility to provide the necessary
financing to bridge the finance gap and find radical solutions to trade-related
intellectual property, in order to ensure that treatment was provided at
affordable prices, particularly in developing nations where an ill relative
could result in hardship and lead to productivity loss at the national level.
These efforts should be complemented by the support of local national and
community-level interventions, and strengthening the role of the family and
civil society in combating non-communicable diseases.

THERESE N’DIRI-YOMAN, Minister for
Health and the Fight against HIV, C ôte d’Ivoire, pointed to the
frightening global data on non-communicable diseases, noting that 36 million
people died annually from them. In developing countries, the picture was more
discouraging. Ninety per cent of premature deaths were due to non-communicable
diseases among people under 60 years of age. In Côte d’Ivoire, most external
resources were spent combating non-communicable diseases. According to the
nation’s 2000 Cancer Register, there were 250,000 new cases in Abuja alone, with
cancer among women topping the list. Prevalence rates were also high among
children. Prevalence of high blood pressure among adults older than 25 years of
age was 33 per cent. Some 33 per cent of deaths in Côte d’Ivoire were due to
non-communicable diseases, mainly among people under age 60. Among women, 59
per cent of deaths were due to maternal and perinatal infections and
malnutrition. Asthma and sickle cell anaemia were also a challenge.

Côte d’Ivoire had taken steps to
prevent non-communicable diseases, including through national nutrition
programmes and strategies to prevent smoking, alcohol abuse and diabetes, she
said. It had taken steps to improve care for such chronic diseases as a matter
of priority in public policy. The 2009-2013 national health development
programme focused on monitoring risk factors in line with WHO guidelines and on
promoting healthy lifestyles and low risk behaviour. The country’s fourth
kidney dialysis centre had recently opened. To treat cancer, the Government was
working with non-traditional institutional partners, such as the Organization of
West African States and the African Union. Côte d’Ivoire’s President, in April
2011, adopted specific cost prevention measures to expand people’s access to
doctors, clinics, medication, and birthing and caesarean services. In August
2011, the Government adopted a 2011-2014 integrated strategy and action plan on
prevention and treatment of non-communicable diseases. She called on
international partners to financially support that action plan, as well as plans
to create a chemotherapy unit and a special trust fund to combat
non-communicable diseases.

BASILE IKOUEBE, Minister of
Foreign Affairs of Congo, said that his country was among the highest in
the world when it came to child mortality, with many children dying before the
age of five. That situation was dire, and was one of the main issues that Congo
sought to correct through the World Health Organization African Region
Ministerial Consultation on Noncommunicable Diseases, held this year in
Brazzaville, Congo. A recent WHO report said that although Africa, as a region,
was reporting more deaths from infectious diseases than non-communicable
diseases, the so-called silent killers are rising rapidly and are projected to
exceed communicable diseases, maternal and childhood conditions and nutritional
deficiencies combined as the most common causes of death by 2030.

During these regional
consultations in Brazzaville on the prevention and control of non-communicable
diseases, the African minsters of health adopted a declaration entitled the
Brazzaville Declaration which outlined the shared position of the member States
of the African region within the WHO. Health was at the heart of human
development, he said, and was an essential component of poverty reduction
strategies. He restated his support for the declaration, as the issue of
non-communicable diseases was so important, and should be included among the
international community’s development goals.

GHULAM NABI AZAD, Minister of
Health and Family Welfare of India, said his country faced the “triple
burden” of communicable diseases, new and re-emerging infections and the
increasing incidence of non-communicable diseases. Due to alarm over their
impact, India held a national summit on non-communicable diseases after the
April 2011 global health minsters conference on the issue. Besides the Delhi
Call for Action, which resulted from that national meeting, ten key messages had
also been issued from the recent WHO South East Asia Regional meeting in Jaipur,
India.

This year India began a $275
million pilot project covering 150 million people in 100 of its least accessible
districts. It included establishment of clinics that made life-saving drugs
available, provided cancer diagnostic and chemotherapy services, and screened
for diabetes and hypertension. “Our target is to screen 150 million people by
March 2012 under this pilot project. This would be the largest such exercise
attempted anywhere in the world. I am happy to state this programme will be
rolled out in the entire country in April 2012,” he said. India’s technological
innovations, such as re-combinant human insulin and poly-pill for prevention of
cardiovascular and stroke events, had led to affordable health care, not only
for India’s people, but for many other countries around the world. But, trade
barriers which restricted access to affordable and newly developed medicines
needed to be addressed.

AMENTA MATTHEW, Minister of Health
of the Marshall Islands, said her country, located in the Central
Pacific, consisted of some 29 atolls and five islets and spread across a sea
area of over 750,000 square miles, was particularly burdened by non-communicable
diseases due to its unique geographical characteristics. In the Marshall
Islands particularly, and the Pacific Region generally, non-communicable
diseases were mainly caused by how the people lived and worked. Of the
estimated 63,900 adult deaths from natural causes that occurred in the Pacific
Island Countries and Territories in 2010, an estimated 75 per cent were due to
non-communicable diseases. Additionally, almost 63 per cent of all premature
deaths in adults aged 15 to 69 years, and 3 out of 4 of all adult deaths, were
caused by non-communicable diseases.

Like other Pacific Island
countries, the Marshall Islands’ had “very limited” resources and its
socio-economic circumstances made it difficult to address non-communicable
diseases. Although a few successes had been recorded, those had been few and
far between. However, she reaffirmed her country’s full commitment to the fast
implementation of the Healthy Islands Action Plan. The country also continued
to forge closer working relationships amongst relevant government sectors,
non-governmental organizations, and civil society, including churches.

FATIM BADJIE, Minister of Health
and Social Welfare of the Gambia, restated his country’s recognition that
health was a vital resource for socio-economic development. It had consequently
invested heavily in infrastructure, service delivery and the requisite human
resources capacity to steer its overall health delivery system.
Non-communicable diseases thrived on rapid lifestyles changes. Yet experts
said that by cutting down on tobacco use and alcohol abuse, being mindful of
unhealthy diets and insufficient physical activity, and putting in place
prevention and management mechanisms for screening and treatment, millions of
lives could be saved globally each year. However, those risk factors could not
be addressed by the individual alone, but required country-specific initiatives
coupled with global action.

She said that, for its part, the
Gambia had enacted its 1998 anti-smoking act, which banned that practice in
public places. It has also ratified the WHO Framework Convention on Tobacco
Control in 2007 and planned to develop a national tobacco control strategy.
Mindful of unhealthy diets, it was also promoting the cultivation and
consumption of home-grown foods through its “back to the land” initiative. The
State had also supported the establishment of a national coalition of
non-governmental organizations for implementing the tobacco Framework Convention
and was finalizing a five-year policy and action plan for preventing and
controlling non-communicable diseases. A Health Promotion Directorate that
would house non-communicable disease initiatives was also being set up.
Addressing the global dimension, he said more efforts, resources and
information sharing must be committed to addressing the causes of
non-communicable diseases within and between countries. Health systems must
also be strengthened to respond to the wide growing challenges posed by
non-communicable diseases, she added.

ALBERTO TEJADA, Minister of Health
of Peru, said that non-communicable diseases were considered “lifestyle
diseases”, and could be more detrimental in middle income countries than in poor
ones, with resulting catastrophic costs. Those diseases were not an accident of
biology, but epidemics to be explained by economic and environmental changes.
However, the good news was that today the international community knew far more
about how to prevent such diseases, and should do what was in its power to
implement such prevention.

While strides had been made in
curtailing the harmful effects of tobacco and alcohol, in terms of diet there
remained much to do, and the international community must defend the culinary
traditions of its peoples by focusing on natural foods, and control advertising
about processed and “junk” food. WHO had warned against such dangers, in
particular with regard to children’s diets, such as in schools. Taxes on junk
food should also be increased, as had been done with tobacco, and breast feeding
should be encouraged for the first six months of life. In addition to
prevention, the international community must work to strengthen its plans to
meet the needs of those who were already ill, particularly the poorest, and
provide access to appropriate care.

LUIS ESTRUCH RANCANO, Vice
Minister for Public Health, Cuba, said life expectancy in Cuba was now 75
years, and Cuba’s Government had sought to reduce non-communicable diseases. It
had reduced the rate of tobacco use by 38 per cent in 10 years. To reduce the
rate of high blood pressure, the Government had instituted ways to reduce public
consumption of salt and sugar. Cuba’s Government had worked to strengthen the
national primary health-care system, with a focus on prevention and improved
attention to children and women. It had adopted a multisectoral approach
involving various ministries to promote sports and the reduction of alcohol and
tobacco consumption. New laws were being drafted in that regard. The central
Government was working with civil society to make women and young people aware
of the risks of alcohol and tobacco use.

The Government was seeking
alliances with the food industry to reduce sugar and salt content in foods, he
said. The Council of Ministers had adopted a 2011-2015 programme to improve
intersectoral health strategies. The global economic crisis and the increasing
effects of climate change had put poor countries in a more difficult position as
they attempted to tackle challenges. As part of efforts to contribute to
international scientific collaboration, thousands of Cubans had offered medical
services abroad. No country was free of the economically unsustainable effects
of non-communicable diseases. Clear economic policies were needed to combat
them.

MAHMOUD MOHAMED FIKRI,
Undersecretary for Health Policy Affairs of the United Arab Emirates,
said that shifts in modern society due to lifestyle changes were leading to an
increase in the prevalence of cardiovascular, respiratory and other chronic
diseases. Non-communicable diseases were the cause of 45 per cent of health
problems today, and were set to increase to 60 per cent in the future. Those
major killers needed government action to control them.

The United Arab Emirates Council
of Health Ministers had adopted major and significant declarations, such as the
Riyadh Declaration on diabetes, the Non-Aligned Movement declaration on
cardiovascular diseases, the declaration on diabetic patients, and the
declaration on non-communicable diseases and diabetes, in addition to measures
to control tobacco. The Council had been awarded a prize from the WHO in 1997.
In order to fight non-communicable diseases, the United Arab Emirates was
adopting a policy initiated in Bahrain for the whole region, to combat
non-communicable diseases, and had also adopted a comprehensive policy to combat
diabetes within the guidelines of the WHO and the international forum on
diabetes, which took place in Dubai in 2010.

RAED ARAFAT, Under-Secretary of
Health of Romania, said he believed the prevention of non-communicable
diseases would reduce poverty, since most of the expenditure for treatment in
small and middle-income countries was paid either within a private system, or
took the form of informal payments. The important role and responsibility of
Governments to respond to the challenges of non-communicable diseases, as well
as an essential need for effort and commitment from all sectors of society to
generate effective responses to prevent and control non-communicable diseases,
was evident. Health must be taken into account in all policies, he
stressed.

Continuing, he said the approach
should be twofold: prevention and early detection and treatment. He observed
that Romania recognized the critical importance of strengthening health systems,
including infrastructure, health care, strengthening human resources in health
and other health and social protection systems, especially in developing
countries, in order to respond in an efficient and equitable way to health care
needs of people with communicable diseases. At the national level, he
emphasised a number of initiatives being undertaken by his Government in support
of goals of the Declaration, and lauded the United Nations for its efforts in
promoting awareness together with an integrated policy to reduce global
inequalities generated by non-communicable diseases.

MURAT TENCER, Head of the
Department of Cancer Control of the Ministry of Health, Turkey, said
non-communicable diseases were the most serious and dangerous problem facing
mankind. Cancer control was vital in tackling that problem. It was essential
to create national cancer control units. Otherwise, all discussions on tackling
cancer would be inconclusive. Regional strategies were needed to tackle cancer,
which was becoming increasingly serious in developing countries. The lack of
coordination was an obstacle. Better coordination among non-governmental
organizations was seriously needed in developing countries. He stressed the
need to create national cancer control institutes. The international community
should promote their creation. Such institutes must have a degree of
independence from health ministries. They must have a scientific dimension and
access to regional resource mechanisms.They must effectively cooperate
with non-governmental organizations and patient advocacy groups in prevention
and screening, human resources and capacity-building, he said. Pointing to
Turkey’s national cancer control programmes and strategies, he said the
Government had invested 2.3 billion euros. Turkey had 170,000 new cancer cases
annually. The Government was focused on prevention, early screening and raising
public awareness about the disease. It had cancer screening and dialysis
centres that tested thousands of people annually. The Government would set up
54 cancer treatment centres in the country by 2023. Turkey was an active member
of the Asia-Pacific Organization for Cancer Prevention, among other regional
organizations. Turkey was ready to share its regional and international
experiences and support with others.

MICHEL TOMMO MONTHE
(Cameroon) said his country would cooperate and collaborate to the
fullest with all partners in order to combat non-communicable diseases. Such
diseases were a new challenge to global efforts to improve health throughout the
world. While the international community gave priority attention to combat
communicable diseases, meanwhile the main four non-communicable diseases
received very little attention in developing countries until they became an
epidemic. The development of those chronic diseases required an assessment over
the years. In the countries of Africa, it was a major threat. The situation
was all the more worrying in that, by 2030, non-communicable diseases were
expected to cause five times the deaths of communicable diseases, including in
low and mid-income countries.

The international community should
ask how it had arrived at such a situation, with a threat at the world level, he
said. There was one reality seen everywhere, which was the changes in lifestyle
following advances in science, technology and development. While some aspects
of progress had improved the quality of life, many lifestyle aspects were in
fact detrimental to health. Without such harmful practices, many
non-communicable diseases would be prevented. Awareness had increased over the
past several years and, since 2000, the world health assembly had adopted a
number of measures. In 2008 the assembly adopted the plan of action to counter
non-communicable diseases, particularly in low- and medium-income countries. In
Cameroon, health policies were focused on communicable diseases and on achieving
the Millennium Development Goals, but had not escaped the emergence of
non-communicable diseases. There were only four years to go to 2015 to achieve
the Millennium Development Goals, but the marked increase in non-communicable
diseases in developing countries was seriously compromising the achievement of
the goals.